Duke Clinical Research Institute, Durham, North Carolina, USA; Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA.
Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.
J Am Coll Cardiol. 2023 Aug 8;82(6):559-571. doi: 10.1016/j.jacc.2023.04.057.
Despite worsening heart failure (HF) being extremely common, expensive, and associated with substantial risk of death, there remain no dedicated clinical practice guidelines for the specific management of these patients. The lack of a management guideline is despite a rapidly evolving evidence-base, as a number of recent clinical trials have demonstrated multiple therapies to be safe and efficacious in this high-risk population. Herein, we propose a framework for treating worsening HF with reduced ejection fraction with the sense of urgency it deserves. This includes treating congestion; managing precipitants; and establishing a foundation of rapid-sequence, simultaneous, and/or in-hospital initiation of quadruple medical therapy for HF with reduced ejection fraction, with the top priority being at least low doses of all 4 medications. Moreover, to maximally reduce residual clinical risk, we further propose consideration of upfront simultaneous use of vericiguat (ie, quintuple medical therapy) and administration of intravenous iron for those who are iron deficient.
尽管心力衰竭（HF）恶化极其常见、昂贵，并伴有死亡的高风险，但对于这些患者的具体管理仍缺乏专门的临床实践指南。尽管有大量新的临床试验证明了多种疗法在这一高危人群中的安全性和有效性，但仍然缺乏管理指南。在此，我们提出了一种框架，以应有的紧迫感来治疗射血分数降低的心力衰竭恶化。这包括治疗充血；管理诱因；并为射血分数降低的心力衰竭建立快速序贯、同时和/或住院起始四重药物治疗的基础，最重要的是至少使用所有 4 种药物的低剂量。此外，为了最大限度地降低残余临床风险，我们还建议对于那些缺铁的患者，考虑 upfront 同时使用维立西呱（即五重药物治疗）和静脉铁剂的治疗。
