Ettrup-Christensen Asbjørn, Butt Jawad H, Andersen Mikkel Porsborg, Sessa Maurizio, Polcwiartek Christoffer, Fosbøl Emil L, Rørth Rasmus, Kristensen Søren L, Torp-Pedersen Christian, Køber Lars, Schou Morten, Tayal Bhupendar, Søgaard Peter, Kragholm Kristian
Department of Cardiology, Aalborg University Hospital, 9000 Aalborg, Denmark.
Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark.
J Cardiovasc Dev Dis. 2023 Aug 25;10(9):362. doi: 10.3390/jcdd10090362.
Data on temporal trends in guideline-based medical and device therapies in real-world chronic heart failure (HF) patients are lacking. Register-based nationwide follow-ups of temporal trends in characteristics, guideline-recommended therapies, one-year all-cause mortality, and HF rehospitalizations in incident HF patients in Denmark during 1996-2019. Among 291,720 incident HF patients, the age at the onset of HF was stable over time. While initially fairly equal, the sex distribution markedly changed over time with more incidents occurring in men overall. Hypertension and diabetes increased significantly over time, while other comorbidities remained stable. Between 1996 and 2019, significant increases in angiotensin-converting enzyme inhibitor and angiotensin II-receptor blocker (ACEi/ARB) therapy (38.2% to 69.9%), beta-blocker therapy (15.5% to 70.6%), and mineralocorticoid receptor antagonist (MRA) therapy (11.8% to 34.5%) were seen. Angiotensin receptor-neprilysin inhibitor (ARNI) and sodium-glucose cotransporter-2 inhibitors (SGLT2i) were introduced in the middle of the past decade, with minor increases but overall low uses: ARNI (2015: 0.1% vs. 2019: 3.9%) and SGLT2i (2012: <0.1% vs. 2019: 3.9%). Between 1999 and 2019, implantable cardioverter-defibrillator (ICD) use increased significantly: 0.1% to 3-4%. Cardiac resynchronization therapy (CRT) use similarly increased between 2000 and 2019: 0.2% to 2.3%. Between 1996 and 2019, one-year all-cause mortality decreased significantly: 34.6% to 20.9%, as did HF rehospitalizations (6% to 1.3%). Among 291,720 incident HF patients in Denmark during 1996-2019, significant increases in the use of ACEi/ARB, beta-blockers, MRAs, and devices were seen, with concurrent significant decreases in the one-year all-cause mortality and HF rehospitalization rates. The use of CRT, ARNI, and SGLT2i remained low, and MRAs were relatively underutilized, thereby representing future targets to potentially further improve HF prognoses.
关于基于指南的医疗和器械疗法在现实世界慢性心力衰竭（HF）患者中的时间趋势数据尚缺。基于登记系统对1996 - 2019年丹麦新发HF患者的特征、指南推荐疗法、一年全因死亡率和HF再住院情况进行全国性随访。在291,720例新发HF患者中，HF发病年龄随时间保持稳定。虽然起初男女比例相当，但随时间推移性别分布明显变化，总体上男性发病更多。高血压和糖尿病随时间显著增加，而其他合并症保持稳定。1996年至2019年期间，血管紧张素转换酶抑制剂和血管紧张素II受体阻滞剂（ACEi/ARB）治疗（从38.2%增至69.9%）、β受体阻滞剂治疗（从15.5%增至70.6%）和盐皮质激素受体拮抗剂（MRA）治疗（从11.8%增至34.5%）显著增加。血管紧张素受体脑啡肽酶抑制剂（ARNI）和钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）在过去十年中期引入，使用略有增加但总体使用率较低：ARNI（2015年：0.1% vs. 2019年：3.9%）和SGLT2i（2012年：<0.1% vs. 2019年：3.9%）。1999年至2019年期间，植入式心脏复律除颤器（ICD）使用显著增加：从0.1%增至3 - 4%。心脏再同步治疗（CRT）使用在2000年至2019年期间同样增加：从0.2%增至2.3%。1996年至2019年期间，一年全因死亡率显著下降：从34.6%降至20.9%，HF再住院率也下降（从6%降至1.3%）。在1996 - 2019年丹麦的291,720例新发HF患者中，ACEi/ARB、β受体阻滞剂、MRA和器械的使用显著增加，同时一年全因死亡率和HF再住院率显著下降。CRT、ARNI和SGLT2i的使用仍然较低，MRA使用相对不足，因此是未来可能进一步改善HF预后的潜在目标。
