Eskişehir Osmangazi Üniversitesi Tıp Fakültesi, Kardiyoloji Anabilim Dalı, Eskişehir.
Başkent Üniversitesi, Kardiyoloji Anabilim Dalı, İstanbul.
Turk Kardiyol Dern Ars. 2022 Jul;50(5):378-394. doi: 10.5543/tkda.2022.22329.
Acute heart failure is associated with high mortality and rehospitalization rates and required urgent evaluation and early initiation or intensification of therapy. The risk of death and heart failure rehospitalization is greatest in the early post-discharge period, particularly within the first 3-6 months, and declines over time, which is referred as a vulnerable period of acute heart failure hospitalization. Therefore, implementation of guidelines-directed optimal therapy is not only so crucial in the acute phase but also very important in the pre-discharge and early post- discharge period in reducing mortality and rehospitalization rates. The pre-discharge period represents a window of opportunity for treatment optimization which includes to eliminate congestion, to treat comorbidities or precipitating factors, and to initiate or uptitrate oral ther- apy before discharge. Early assessment in the post-discharge period based on clinical evalu- ation and laboratory exams, further optimization of disease-modifying therapy is associated with lower 30-day hospitalization for heart failure. In clinical practice, clinicians usually focus on acute phase intravenous medications and short-term device therapies and, in fact, neglect short- and long-term comprehensive approaches. This paper reviews management strategies that may help reduce mortality and heart failure rehospitalizations in pre-discharge and post- discharge periods and include adopting holistic approaches for heart failure, increasing optimi- zation of evidence-based therapies, treating cardiac and noncardiac comorbidities, improving care transitions, monitoring, and disease management.
急性心力衰竭与高死亡率和再住院率相关，需要紧急评估，并早期开始或加强治疗。在出院后的早期阶段，尤其是在出院后的 3-6 个月内，死亡和心力衰竭再住院的风险最大，并且随着时间的推移而下降，这被称为急性心力衰竭住院的脆弱期。因此，实施指南指导的最佳治疗不仅在急性期至关重要，而且在出院前和出院后早期也非常重要，可以降低死亡率和再住院率。出院前阶段是治疗优化的机会窗口，包括消除充血、治疗合并症或诱发因素，并在出院前开始或增加口服治疗。出院后根据临床评估和实验室检查进行早期评估，进一步优化疾病修正治疗与降低 30 天心力衰竭住院率相关。在临床实践中，临床医生通常关注急性阶段的静脉内药物和短期设备治疗，实际上忽视了短期和长期的综合方法。本文回顾了可能有助于降低出院前和出院后死亡率和心力衰竭再住院率的管理策略，包括采用整体方法治疗心力衰竭、增加基于证据的治疗的优化、治疗心脏和非心脏合并症、改善护理过渡、监测和疾病管理。
