Vazir Ali, Kapelios Chris J, Agaoglu Elif, Metra Marco, Lopatin Yury, Seferovic Petar, Mullens Wilfred, Filippatos Gerasimos, Rosano Giuseppe, Coats Andrew J S, Chioncel Ovidiu
Royal Brompton Hospital, Royal Brompton and Harefield Hospitals Part of Guy's and St Thomas' NHS Foundation Trust, London, UK.
National Heart and Lung Institute, Imperial College London, London, UK.
Eur J Heart Fail. 2023 Sep;25(9):1555-1570. doi: 10.1002/ejhf.2985. Epub 2023 Sep 7.
Decongestion strategies for acute decompensated heart failure (ADHF) characterized by volume overload differ widely. The aim of this independent international academic web-based survey was to capture the therapeutic strategies that physicians use to treat ADHF and to assess differences in therapeutic approaches between cardiologists versus non-cardiologists.
Physicians were invited to complete a web-based questionnaire, capturing anonymized data on physicians' characteristics and treatment preferences based on a hypothetical clinical scenario of a patient hospitalized with ADHF. A total of 641 physicians from 60 countries participated. A wide variation in the management of the patient was observed. There was conservative use of diuretics, i.e. only 7% started intravenous furosemide at a dose ≥2 times the baseline oral dose, and infrequent use of ultrasound in assessing congestion (20.4%). Spot urinary sodium was infrequently or never measured by ≥85% of physicians. A third considered a patient with ongoing oedema as being stabilized. There were significant differences between cardiologists and non-cardiologists in the management of ADHF, the targets for daily body weight loss and urine output, diuretic escalation strategies (66.3% vs. 40.7% would escalate diuresis by adding a thiazide) and assessment of response to treatment (27.0% vs. 52.9% considered patients with minimal congestion as stabilized).
There is substantial variability amongst physicians and between cardiologists and non-cardiologists in the management of patients with ADHF, with regard to clinical parameters used to tailor treatment, treatment goals, diuretic dosing and escalation strategies.
以容量超负荷为特征的急性失代偿性心力衰竭（ADHF）的消肿策略差异很大。这项基于网络的独立国际学术调查的目的是了解医生用于治疗ADHF的治疗策略，并评估心脏病专家与非心脏病专家在治疗方法上的差异。
邀请医生完成一份基于网络的问卷，根据一名因ADHF住院患者的假设临床情况，收集有关医生特征和治疗偏好的匿名数据。来自60个国家的641名医生参与了调查。观察到对该患者的管理存在很大差异。利尿剂的使用较为保守，即只有7%的医生开始静脉注射呋塞米，剂量≥基线口服剂量的2倍，且很少使用超声评估充血情况（20.4%）。≥85%的医生很少或从未测量过随机尿钠。三分之一的医生认为持续水肿的患者已病情稳定。心脏病专家和非心脏病专家在ADHF的管理、每日体重减轻和尿量目标、利尿剂升级策略（66.3%对40.7%会通过加用噻嗪类药物增加利尿）以及治疗反应评估（27.0%对52.9%认为充血轻微的患者病情已稳定）方面存在显著差异。
在ADHF患者的管理方面，医生之间以及心脏病专家与非心脏病专家之间在用于调整治疗的临床参数、治疗目标、利尿剂给药和升级策略方面存在很大差异。
