Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, NC.
Department of Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX.
J Card Fail. 2023 May;29(5):818-831. doi: 10.1016/j.cardfail.2023.02.015. Epub 2023 Mar 22.
Despite treatment with contemporary medical therapies for chronic heart failure (HF), there has been an increase in the prevalence of patients progressing to more advanced disease. Patients progressing to and living at the interface of severe stage C and stage D HF are underrepresented in clinical trials, and there is a lack of high-quality evidence to guide clinical decision making. For patients with severe HF phenotypes, the medical therapies used for patients with less advanced stages of illness are often no longer tolerated or provide inadequate clinical stability. The limited data on these patients highlights the need to increase formal research characterizing this high-risk population. This review summarizes existing clinical trial data and incorporates our considerations for approaches to the medical management of patients advanced "beyond stage C" HF.
尽管采用了当代慢性心力衰竭（HF）的医学治疗方法，但进展为更晚期疾病的患者比例仍在增加。在临床试验中，进展为严重 C 期和 D 期 HF 并处于疾病晚期的患者代表性不足，缺乏高质量的证据来指导临床决策。对于严重 HF 表型的患者，用于疾病进展程度较低的患者的医学治疗方法通常不再耐受或不能提供足够的临床稳定性。这些患者的数据有限，突出了增加对这一高危人群进行特征描述的正式研究的必要性。本综述总结了现有临床试验数据，并结合了我们对治疗“超越 C 期”HF 患者的医学管理方法的考虑。
