用于射血分数降低的慢性心力衰竭药物剂量递增的每日动态远程监测系统：DAVID-HF研究的试点阶段
Daily ambulatory remote monitoring system for drug escalation in chronic heart failure with reduced ejection fraction: pilot phase of DAVID-HF study.
作者信息
Wong Chun Ka, Un Ka Chun, Zhou Mi, Cheng Yangyang, Lau Yuk Ming, Shea Puigi Catherine, Lui Hin Wai, Zuo Ming Liang, Yin Li Xue, Chan Esther W, Wong Ian C K, Sin Simon Wai Ching, Yeung Pauline Pui Ning, Chen Hao, Wibowo Sandi, Wei Tong Li Nikki, Lee Sze Ming, Chow Augustine, Tong Raymond Cheuk Fung, Hai Jojo, Tam Frankie Chor Cheung, Siu Chung Wah
机构信息
Division of Cardiology, Department of Medicine, The University of Hong Kong, Hong Kong SAR, China.
Department of Echocardiography & Non-invasive Cardiology Laboratory, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, China.
出版信息
Eur Heart J Digit Health. 2022 May 7;3(2):284-295. doi: 10.1093/ehjdh/ztac024. eCollection 2022 Jun.
AIMS
Underutilization of guideline-directed heart failure with reduced ejection fraction (HFrEF) medications contributes to poor outcomes.
METHODS AND RESULTS
A pilot study to evaluate the safety and efficacy of a home-based remote monitoring system for HFrEF management was performed. The system included wearable armband monitors paired with the smartphone application. An HFrEF medication titration algorithm was used to adjust medication daily. The primary endpoint was HFrEF medication utilization at 120 days. Twenty patients (60.5 ± 8.2 years, men: 85%) with HFrEF were recruited. All received angiotensin-converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB)/angiotensin receptor-neprilysin inhibitor (ARNI) at recruitment; 45% received ≥50% maximal targeted dose (MTD) with % MTD of 44.4 ± 31.7%. At baseline, 90 and 70% received beta-adrenergic blocker and mineralocorticoid receptor antagonist (MRA), 35% received ≥50% MTD beta-adrenergic blocker with % MTD of 34.1 ± 29.6%, and 25% received ≥50% MTD MRA with % MTD of 25.0 ± 19.9%. At 120 days, 70% received ≥50% MTD ACEI/ARB/ARNI ( = 0.110) with % MTD increased to 64.4 ± 33.5% ( = 0.060). The proportion receiving ≥50% MTD ARNI increased from 15 to 55% ( = 0.089) with % MTD ARNI increased from 20.6 ± 30.9 to 53.1 ± 39.5% ( = 0.006*). More patients received ≥50% MTD MRA (65 vs. 25%, = 0.011*) with % MTD MRA increased from 25.0 ± 19.9 to 46.2 ± 28.8% ( = 0.009*). Ninety-five per cent of patients had reduced NT-proBNP with the percentage reduction of 26.7 ± 19.7%.
CONCLUSION
Heart failure with reduced ejection fraction medication escalation with remote monitoring appeared feasible.
目的
射血分数降低的心力衰竭（HFrEF）药物使用不足会导致不良后果。
方法与结果
开展了一项试点研究，以评估基于家庭的远程监测系统用于HFrEF管理的安全性和有效性。该系统包括与智能手机应用程序配对的可穿戴臂带监测器。采用HFrEF药物滴定算法每日调整药物。主要终点是120天时HFrEF药物的使用情况。招募了20例HFrEF患者（60.5±8.2岁，男性占85%）。所有患者在入组时均接受血管紧张素转换酶抑制剂（ACEI）/血管紧张素受体阻滞剂（ARB）/血管紧张素受体脑啡肽酶抑制剂（ARNI）治疗；45%的患者接受了≥50%的最大目标剂量（MTD），MTD百分比为44.4±31.7%。基线时，90%和70%的患者接受β-肾上腺素能阻滞剂和盐皮质激素受体拮抗剂（MRA）治疗，35%的患者接受≥50% MTD的β-肾上腺素能阻滞剂，MTD百分比为34.1±29.6%，25%的患者接受≥50% MTD的MRA，MTD百分比为25.0±19.9%。在120天时，70%的患者接受≥50% MTD的ACEI/ARB/ARNI（P = 0.110），MTD百分比增加至64.4±33.5%（P = 0.060）。接受≥50% MTD ARNI的比例从15%增加到55%（P = 0.089），ARNI的MTD百分比从20.6±30.9增加到53.1±39.5%（P = 0.006*）。更多患者接受了≥50% MTD的MRA（65%对25%，P = 0.011*），MRA的MTD百分比从25.0±19.9增加到46.2±28.8%（P = 0.009*）。95%的患者NT-proBNP降低，降低百分比为26.7±19.7%。
结论
通过远程监测逐步增加射血分数降低的心力衰竭药物剂量似乎是可行的。
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