Greene Stephen J, Bauersachs Johann, Brugts Jasper J, Ezekowitz Justin A, Lam Carolyn S P, Lund Lars H, Ponikowski Piotr, Voors Adriaan A, Zannad Faiez, Zieroth Shelley, Butler Javed
Duke Clinical Research Institute, Durham, North Carolina, USA; Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA.
Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.
J Am Coll Cardiol. 2023 Jan 31;81(4):413-424. doi: 10.1016/j.jacc.2022.11.023.
Heart failure (HF) is a progressive disease characterized by variable durations of symptomatic stability often punctuated by episodes of worsening despite continued therapy. These periods of clinical worsening are increasingly recognized as a distinct phase in the history of HF, termed worsening HF (WHF). The definition of WHF continues to evolve from a historical focus solely on hospitalization to now include nonhospitalization events (eg, need for intravenous diuretic therapy in the emergency or outpatient setting). Most HF clinical trials to date have had HF hospitalization and death as primary endpoints, and only recently, some studies have included other WHF events regardless of location of care. This article reviews the evolution of the WHF definition, highlights the importance of considering the onset of WHF as an event that marks a new phase of HF, summarizes the latest clinical trials investigating novel therapies, and outlines unmet needs regarding identification and treatment of WHF.
心力衰竭（HF）是一种进行性疾病，其特征是症状稳定期持续时间不定，尽管持续治疗，但常被病情恶化发作打断。这些临床恶化期越来越被认为是HF病程中的一个独特阶段，称为恶化性心力衰竭（WHF）。WHF的定义不断演变，从历史上仅关注住院治疗，到现在包括非住院事件（如在急诊或门诊环境中需要静脉利尿剂治疗）。迄今为止，大多数HF临床试验都将HF住院和死亡作为主要终点，直到最近，一些研究才纳入了其他WHF事件，而不考虑治疗地点。本文回顾了WHF定义的演变，强调将WHF的发作视为标志HF新阶段的事件的重要性，总结了研究新疗法的最新临床试验，并概述了在WHF识别和治疗方面未满足的需求。
