急性心力衰竭住院后，符合既定和新型指南指导的医学治疗的患者。
Patient Eligibility for Established and Novel Guideline-Directed Medical Therapies After Acute Heart Failure Hospitalization.
机构信息
Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.
Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada.
出版信息
JACC Heart Fail. 2023 May;11(5):596-606. doi: 10.1016/j.jchf.2022.10.013. Epub 2023 Jan 11.
BACKGROUND
Acute heart failure (AHF) hospitalization presents an opportunity to optimize pharmacotherapy to improve outcomes.
OBJECTIVES
This study's aim was to define eligibility for initiation of guideline-directed medical therapy and newer heart failure (HF) agents from recent clinical trials in the AHF population.
METHODS
The authors analyzed patients with an AHF admission within the CAN-HF (Canadian Heart Failure) registry between January 2017 and April 2020. Heart failure with reduced ejection fraction (HFrEF) was defined as left ventricular ejection fraction (LVEF) ≤40% and heart failure with preserved ejection fraction (HFpEF) as LVEF >40%. Eligibility was assessed according to the major society guidelines or enrollment criteria from recent landmark clinical trials.
RESULTS
A total of 809 patients with documented LVEF were discharged alive from hospital: 455 with HFrEF and 354 with HFpEF; of these patients, 284 had a de novo presentation and 525 had chronic HF. In HFrEF patients, eligibility for therapies was 73.6% for angiotensin receptor-neprilysin inhibitors (ARNIs), 94.9% for beta-blockers, 84.4% for mineralocorticoid receptor antagonists (MRAs), 81.1% for sodium-glucose cotransporter-2 (SGLT2) inhibitors, and 15.6% for ivabradine. Additionally, 25.9% and 30.1% met trial criteria for vericiguat and omecamtiv mecarbil, respectively. Overall, 71.6% of patients with HFrEF (75.5% de novo, 69.5% chronic HF) were eligible for foundational quadruple therapy. In the HFpEF population, 37.6% and 59.9% were eligible for ARNIs and SGLT2 inhibitors based on recent trial criteria, respectively.
CONCLUSIONS
The majority of patients admitted with AHF are eligible for foundational quadruple therapy and additional novel medications across a spectrum of HF phenotypes.
背景
急性心力衰竭（AHF）住院为优化药物治疗以改善预后提供了机会。
目的
本研究旨在确定最近 AHF 人群临床试验中指南指导的医学治疗和新型心力衰竭（HF）药物的起始适应证。
方法
作者分析了 2017 年 1 月至 2020 年 4 月期间 CAN-HF（加拿大心力衰竭）登记处内因 AHF 入院的患者。射血分数降低的心力衰竭（HFrEF）定义为左心室射血分数（LVEF）≤40%，射血分数保留的心力衰竭（HFpEF）定义为 LVEF＞40%。根据主要学会指南或最近的标志性临床试验的入组标准评估适应证。
结果
共有 809 例有记录的 LVEF 的患者从医院存活出院：455 例为 HFrEF，354 例为 HFpEF；其中 284 例为新发表现，525 例为慢性 HF。在 HFrEF 患者中，血管紧张素受体-脑啡肽酶抑制剂（ARNI）的治疗适应证为 73.6%，β受体阻滞剂为 94.9%，盐皮质激素受体拮抗剂（MRA）为 84.4%，钠-葡萄糖共转运蛋白 2（SGLT2）抑制剂为 81.1%，伊伐布雷定为 15.6%。此外，分别有 25.9%和 30.1%的患者符合维立西呱和奥马卡林美卡比的试验标准。总体而言，71.6%的 HFrEF 患者（75.5%为新发，69.5%为慢性 HF）有资格接受基础四联治疗。在 HFpEF 人群中，分别有 37.6%和 59.9%的患者基于最近的试验标准有资格使用 ARNI 和 SGLT2 抑制剂。
结论
大多数因 AHF 入院的患者有资格接受基础四联治疗和 HF 表型谱内的其他新型药物。
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