Phan Joseph, Barroca Crystal, Fernandez Joel
Department of Internal Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Clearwater, USA.
Division of Cardiovascular Sciences, Department of Internal Medicine, University of South Florida (USF) Health Morsani College of Medicine, Tampa, USA.
Cureus. 2023 Feb 28;15(2):e35602. doi: 10.7759/cureus.35602. eCollection 2023 Feb.
The vulnerable phase (VP) of heart failure (HF) is 30 to 90 days after hospital discharge and is associated with increased rehospitalization and mortality rates. The pathophysiological mechanism that drives the VP is due to the progressive increase in left ventricular filling pressure, which can cause hemodynamic congestion and long-term multiorgan injury. Our team analyzed English-written, peer-reviewed research through PubMed from 2018 to 2022, to gather current information on the VP and generate a multipronged approach toward the assessment and intervention of patients with posthospitalization HF. It is our opinion that a structured approach using remote vital monitoring and risk-stratifying tools will be best to identify patients at risk for decompensatory HF during the VP. Medical management can then be targeted toward these high-risk patients by using an organized multidisciplinary team and a disease management program, which includes remote patient-monitoring systems, addressing social determinants of health, and cardiac rehabilitation, to improve rehospitalization and mortality rates.
心力衰竭（HF）的脆弱期（VP）是出院后30至90天，与再住院率和死亡率增加相关。驱动脆弱期的病理生理机制是左心室充盈压逐渐升高，这可导致血流动力学充血和长期多器官损伤。我们的团队通过PubMed分析了2018年至2022年英文撰写的、同行评审的研究，以收集有关脆弱期的当前信息，并针对出院后心力衰竭患者制定多方面的评估和干预方法。我们认为，使用远程生命监测和风险分层工具的结构化方法最有助于识别脆弱期内有失代偿性心力衰竭风险的患者。然后，可以通过组建有组织的多学科团队和疾病管理计划，针对这些高危患者进行医疗管理，该计划包括远程患者监测系统、解决健康的社会决定因素以及心脏康复，以提高再住院率和降低死亡率。
