心力衰竭伴射血分数降低(HFrEF)患者在心脏康复期间以及 3 个月和 6 个月后的药物治疗依从性。

Adherence to drug therapy in patients with heart failure associated with reduced ejection fractions (HFrEF) during cardiac rehabilitation and after 3 and 6 months.

机构信息

Paracelsus Harzklinik Bad Suderode GmbH, Paracelsusstraße 1, 06485, Quedlinburg, Germany.

Clinic Ruedersdorf and Faculty of Human Sciences, University of Potsdam, Potsdam, Germany.

出版信息

Clin Res Cardiol. 2024 Jun;113(6):866-874. doi: 10.1007/s00392-023-02314-0. Epub 2023 Oct 5.

Abstract

INTRODUCTION

Heart failure represents a major challenge for healthcare systems worldwide. Rehabilitation is recommended as an important pillar of therapy for these patients, especially for those with reduced left ventricular ejection fraction (HFrEF: heart failure with reduced ejection fraction).

METHODS

The data collected in this multi-center project provide information on the rates of patients with HFrEF who were treated in five German rehabilitation facilities and whether the patients adhered to drug therapy at 3-/6-month follow-up. The project was supported by an unrestricted grant from Novartis-Pharma-GmbH.

RESULTS

The mean age of the 234 patients included was 63.4 ± 10.6 years and 78% were male. The mean LVEF was 31 ± 8% at admission and 36 ± 10% at discharge. Only 20.6% of the patients were assigned to rehabilitation with the main indication HF. The most frequent main indication was acute coronary syndrome (46.6%). A high proportion of patients was already on the recommended drug therapy upon admission (94% beta blockers, 100% angiotensin-effective drugs, 70% mineralocorticoid receptor antagonists, etc.). This was optimized, in particular by a higher proportion of patients treated with sodium-glucose cotransporter-2 inhibitors (35% admission vs. 45% discharge) and sacubitril/valsartan (49% admission vs. 64% discharge), which was further optimized during the 6-month follow-up (e.g., 50% SGLT2 inhibitors, 67% sacubitril/valsartan).

DISCUSSION

These data illustrate the effect of rehabilitation in terms of optimizing drug therapy, which stabilized over the course of 6 months. Furthermore, only a few patients with the main diagnosis HFrEF are referred for cardiac rehabilitation, although it is an essential part of guideline-based therapy.

摘要

简介

心力衰竭是全球医疗体系面临的主要挑战。康复治疗被推荐为这些患者的重要治疗手段,尤其适用于左心室射血分数降低(HFrEF:射血分数降低的心力衰竭)的患者。

方法

该多中心项目收集的数据提供了在德国五家康复机构接受治疗的 HFrEF 患者的比率信息,以及患者在 3 个月/6 个月随访时是否坚持药物治疗。该项目得到了诺华制药公司的一项非限制赠款的支持。

结果

纳入的 234 例患者的平均年龄为 63.4±10.6 岁,78%为男性。入院时的平均 LVEF 为 31±8%,出院时为 36±10%。只有 20.6%的患者被指定进行以心力衰竭为主要适应证的康复治疗。最常见的主要适应证是急性冠状动脉综合征(46.6%)。很大一部分患者入院时已经接受了推荐的药物治疗(94%的β受体阻滞剂,100%的血管紧张素有效药物,70%的盐皮质激素受体拮抗剂等)。这一治疗方案得到了优化,特别是接受钠-葡萄糖协同转运蛋白 2 抑制剂(35%入院时 vs. 45%出院时)和沙库巴曲缬沙坦(49%入院时 vs. 64%出院时)治疗的患者比例更高,且在 6 个月随访期间进一步优化(例如,50%的 SGLT2 抑制剂,67%的沙库巴曲缬沙坦)。

讨论

这些数据说明了康复治疗在优化药物治疗方面的效果,且这种效果在 6 个月的过程中保持稳定。此外,尽管康复治疗是基于指南的治疗的重要组成部分,但只有少数主要诊断为 HFrEF 的患者被转介进行心脏康复治疗。

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