Danish Heart Foundation, Copenhagen, Denmark.
Department of Cardiology, Herlev and Gentofte Hospital, Herlev, Hellerup, Denmark.
PLoS One. 2023 Jun 8;18(6):e0286307. doi: 10.1371/journal.pone.0286307. eCollection 2023.
Whether continued follow-up in specialized heart failure (HF) clinics after optimization of guideline-directed therapy improves long-term outcomes in patients with HF with reduced ejection fraction (HFrEF) is unknown.
921 medically optimized HFrEF patients enrolled in the NorthStar study were randomly assigned to follow up in a specialized HF clinic or primary care and followed for 10 years using Danish nationwide registries. The primary outcome was a composite of HF hospitalization or cardiovascular death. We further assessed the 5-year adherence to prescribed neurohormonal blockade in 5-year survivors. At enrollment, the median age was 69 years, 24,7% were females, and the median NT-proBNP was 1139 pg/ml. During a median follow-up time of 4.1 (Q1-Q3 1.5-10.0) years, the primary outcome occurred in 321 patients (69.8%) randomized to follow-up in specialized HF clinics and 325 patients (70.5%) randomized to follow-up in primary care. The rate of the primary outcome, its individual components, and all-cause death did not differ between groups (primary outcome, hazard ratio 0.96 [95% CI, 0.82-1.12]; cardiovascular death, 1.00 [0.81-1.24]; HF hospitalization, 0.97 [0.82-1.14]; all-cause death, 1.00 [0.83-1.20]). In 5-year survivors (N = 660), the 5-year adherence did not differ between groups for angiotensin-converting enzyme inhibitors (p = 0.78), beta-blockers (p = 0.74), or mineralocorticoid receptor antagonists (p = 0.47).
HFrEF patients on optimal medical therapy did not benefit from continued follow-up in a specialized HF clinic after initial optimization. Development and implementation of new monitoring strategies are needed.
在优化指南指导的治疗后，继续在专门的心衰（HF）诊所进行随访是否能改善射血分数降低的心力衰竭（HFrEF）患者的长期预后尚不清楚。
921 名接受医学优化的 HFrEF 患者被纳入 NorthStar 研究，并随机分配到专门的 HF 诊所或初级保健进行随访，并使用丹麦全国登记处进行了 10 年的随访。主要结局是 HF 住院或心血管死亡的复合结局。我们进一步评估了 5 年幸存者中神经激素阻滞剂的 5 年依从性。在入组时，中位年龄为 69 岁，24.7%为女性，中位 NT-proBNP 为 1139 pg/ml。在中位随访时间为 4.1 年（Q1-Q3 1.5-10.0）期间，主要结局发生在 321 名（69.8%）随机分配到专门 HF 诊所随访的患者和 325 名（70.5%）随机分配到初级保健随访的患者中。主要结局及其各组成部分和全因死亡的发生率在两组之间没有差异（主要结局，风险比 0.96 [95%CI，0.82-1.12]；心血管死亡，1.00 [0.81-1.24]；HF 住院，0.97 [0.82-1.14]；全因死亡，1.00 [0.83-1.20]）。在 5 年幸存者（N=660）中，ACEI（p=0.78）、β受体阻滞剂（p=0.74）或盐皮质激素受体拮抗剂（p=0.47）的 5 年依从性在两组之间没有差异。
接受最佳药物治疗的 HFrEF 患者在初始优化后并未从专门的心衰诊所的持续随访中获益。需要开发和实施新的监测策略。
