Heart Failure & Cardio-Oncology Unit, Alexandra Hospital, Athens, Greece.
1st Cardiology Clinic, University of Athens, Hippokratio Hospital, Athens, Greece.
Heart Fail Rev. 2022 Jan;27(1):1-13. doi: 10.1007/s10741-021-10115-8. Epub 2021 May 1.
The short-term mortality and rehospitalization rates after admission for acute heart failure (AHF) remain high, despite the high level of adherence to contemporary practice guidelines. Observational data from non-randomized studies in AHF strongly support the in-hospital administration of oral evidence-based modifying chronic heart failure (HF) medications (i.e., b-blockers, ACE inhibitors, mineralocorticoid receptor antagonists) to reduce morbidity and mortality. Interestingly, a well-designed prospective randomized multicenter study (PIONEER-HF) showed an improved clinical outcome and stress/injury biomarker profile after in-hospital administration of sacubitril/valsartan (sac/val) as compared to enalapril, in hemodynamically stable patients with AHF. However, sac/val implementation during hospitalization remains suboptimal due to the lack of an integrated individualized plan or well-defined appropriateness criteria for transition to oral therapies, an absence of specific guidelines regarding dose selection and the up-titration process, and uncertainty regarding patient eligibility.In the present expert consensus position paper, clinical practical recommendations are proposed, together with an action plan algorithm, to encourage and facilitate sac/val administration during hospitalization after an AHF episode with the aim of improving efficiencies of care and resource utilization.
尽管当代实践指南的遵循度很高，但急性心力衰竭（AHF）患者住院后的短期死亡率和再住院率仍然很高。来自非随机 AHF 观察性研究的数据强烈支持在院内给予口服循证治疗慢性心力衰竭（HF）的药物（即β受体阻滞剂、ACE 抑制剂、盐皮质激素受体拮抗剂），以降低发病率和死亡率。有趣的是，一项设计良好的前瞻性随机多中心研究（PIONEER-HF）表明，与依那普利相比，在血流动力学稳定的 AHF 患者中，院内给予沙库巴曲缬沙坦（sac/val）可改善临床结局和应激/损伤生物标志物谱。然而，由于缺乏整合的个体化计划或明确的过渡到口服治疗的适宜性标准、剂量选择和滴定过程的具体指南，以及对患者资格的不确定性，住院期间 sac/val 的应用仍然不理想。在本专家共识立场文件中，提出了临床实用建议，并附有行动计划算法，以鼓励和促进 AHF 发作后在院内给予 sac/val，旨在提高护理效率和资源利用。
