射血分数降低的心力衰竭患者医生遵循指南指导药物治疗的分析：一项真实世界研究
Analysis of Physician Compliance with Guideline-Directed Medical Therapy for Patients with Heart Failure with Reduced Ejection Fraction: A Real-World Study.
作者信息
Wang Guixia, Liu Liming, Wang Xiaobo, Yu Ting, Xu Hui, Zhang Tingjun, Lin Jiafu, Luo Hao, Liu Yanxu, Jiang Lanxiang, Hu Wenlong, Hu Houxiang
机构信息
The First Affiliated Hospital, Jinan University, 510630 Guangzhou, Guangdong, China.
Infectious Department, Affiliated Hospital of North Sichuan Medical College, 2262110 Nanchong, Sichuan, China.
出版信息
Rev Cardiovasc Med. 2023 Sep 18;24(9):257. doi: 10.31083/j.rcm2409257. eCollection 2023 Sep.
BACKGROUND
Although compliance with the guideline recommendations for heart failure (HF) is associated with improved survival, the effects of medication on clinical practice often fail to meet expectations due to physician and/or patient-related reasons that are unclear. This study analyzed physicians' compliance with guideline-directed medical therapy (GDMT) based on real-world clinical data and identified risk factors of low compliance.
METHODS
This study included patients with HF, who were treated at the Affiliated Hospital of North Sichuan Medical College from July 2017 to June 2021. All patients were divided into high compliance, moderate compliance, and low compliance with GDMT groups. The proportion of patients receiving treatment in compliance with GDMT was analyzed, the relationship between compliance with GDMT and clinical outcomes was evaluated, and the risk factors of low compliance were identified.
RESULTS
Of all patients with HF included in the study, 498 (23.8%) had low compliance with GDMT, 1413 (67.4%) had moderate compliance with GDMT, and 185 (8.8%) had high compliance with GDMT. The readmission rate of patients in the moderate compliance with GDMT group was significantly higher than that in the high and low compliance groups ( = 0.028). There were no significant differences in the rates of severe cardiovascular disease among the three groups. The mortality rate of patients in the high compliance with GDMT group was significantly higher than that of the other groups ( 0.001). We found that a history of hypertension; New York Heart Association (NYHA) classification (III and IV vs. I); and abnormal heart rate, high-sensitive troponin T (hsTnT), N-terminal prohormone of brain natriuretic peptide (NT-proBNP), uric acid, and left ventricular diastolic dysfunction (LVDD) were all significantly associated with low compliance with GDMT.
CONCLUSIONS
The proportion of physicians' compliance with GDMT in treating patients with HF is low. Risk factors of low compliance include hypertension; NYHA classification (III and IV vs. I); and abnormal heart rate, hsTnT, NT proBNP, uric acid, and LVDD.
背景
尽管遵循心力衰竭（HF）指南建议与生存率提高相关，但由于尚不清楚的医生和/或患者相关原因，药物治疗对临床实践的效果往往未达预期。本研究基于真实世界临床数据分析医生对指南导向药物治疗（GDMT）的依从性，并确定低依从性的风险因素。
方法
本研究纳入2017年7月至2021年6月在川北医学院附属医院接受治疗的HF患者。所有患者分为GDMT高依从性、中度依从性和低依从性组。分析接受符合GDMT治疗的患者比例，评估GDMT依从性与临床结局的关系，并确定低依从性的风险因素。
结果
在纳入研究的所有HF患者中，498例（23.8%）对GDMT依从性低，1413例（67.4%）对GDMT中度依从，185例（8.8%）对GDMT高依从。GDMT中度依从组患者的再入院率显著高于高依从组和低依从组（P = 0.028）。三组间严重心血管疾病发生率无显著差异。GDMT高依从组患者的死亡率显著高于其他组（P < 0.001）。我们发现高血压病史、纽约心脏协会（NYHA）分级（III级和IV级 vs. I级）以及心率异常、高敏肌钙蛋白T（hsTnT）、脑钠肽前体N末端（NT-proBNP）、尿酸和左心室舒张功能障碍（LVDD）均与GDMT低依从性显著相关。
结论
医生在治疗HF患者时对GDMT的依从性比例较低。低依从性的风险因素包括高血压、NYHA分级（III级和IV级 vs. I级）以及心率异常、hsTnT、NT-proBNP、尿酸和LVDD。
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