Department of Cardiology, Tulane University Medical Center, 1415 Tulane Ave, New Orleans, LA 70112, USA; Southeast Louisiana Veterans Healthcare System, 2400 Canal Street, New Orleans, LA 70119, USA.
Department of Cardiology, Tulane University Medical Center, 1415 Tulane Ave, New Orleans, LA 70112, USA; Southeast Louisiana Veterans Healthcare System, 2400 Canal Street, New Orleans, LA 70119, USA.
Am J Med Sci. 2024 Sep;368(3):182-189. doi: 10.1016/j.amjms.2024.06.002. Epub 2024 Jun 14.
Incomplete decongestion is the main cause of readmission in the early post-discharge period of a hospitalization for acute heart failure. Recent heart failure guidelines have highlighted initiation and rapid up-titration of quadruple therapy with angiotensin receptor neprilysin inhibitor, beta adrenergic receptor blocker, mineralocorticoid receptor antagonist, and sodium glucose cotransporter 2 inhibitor to prevent hospitalizations for heart failure with reduced ejection fraction. However, full decongestion remains the foremost therapeutic goal of hospitalization for heart failure. While early addition of sodium glucose cotransporter 2 inhibitors and mineralocorticoid receptor antagonists may be helpful, the value of the other therapeutics comes after decongestion is complete.
不完全的解除充血是急性心力衰竭住院后早期再入院的主要原因。最近的心力衰竭指南强调了起始并快速滴定血管紧张素受体脑啡肽酶抑制剂、β肾上腺素能受体阻滞剂、盐皮质激素受体拮抗剂和钠-葡萄糖共转运体 2 抑制剂的四联疗法，以预防射血分数降低的心力衰竭住院。然而，完全解除充血仍然是心力衰竭住院的首要治疗目标。尽管早期加用钠-葡萄糖共转运体 2 抑制剂和盐皮质激素受体拮抗剂可能有帮助，但在充血解除完全后，其他治疗药物的价值才会显现。
