Oskouie Suzanne, Pandey Ambarish, Sauer Andrew J, Greene Stephen J, Mullens Wilfried, Khan Muhammad Shahzeb, Quinn Kieran L, Ho Jennifer E, Albert Nancy M, Van Spall Harriette Gc
Division of Cardiology, University of Arizona Sarver Heart Center, Tucson, Arizona, USA.
Division of Cardiology, UT Southwestern Medical Center, Dallas, Texas, USA.
JACC Adv. 2024 Jul 31;3(9):101131. doi: 10.1016/j.jacadv.2024.101131. eCollection 2024 Sep.
Heart failure (HF) is a leading cause of hospitalization in older adults. Patients are at high risk of readmission and death following hospitalization for HF. There is no standard approach of health care delivery during the hospital-to-home transition period, leaving missed opportunities in care optimization. In this review, we discuss contemporary randomized clinical trials that tested decongestion strategies, disease-modifying therapies, and health care services that inform the care of patients with worsening HF. We provide evidence-informed recommendations for optimizing therapies and improving outcomes during and following hospitalization for HF. These include adequate decongestion with loop diuretics and select sequential nephron blockade strategies based on early evaluation of diuretic response; initiation of disease-modifying pharmacotherapies prior to hospital discharge with close follow-up and optimization after discharge; cardiac rehabilitation; and transitional or palliative care referral post-hospitalization. Evidence-based implementation strategies to facilitate broad uptake include digital health tools and algorithm-driven optimization of pharmacotherapies.
心力衰竭（HF）是老年人住院治疗的主要原因。心力衰竭患者住院后再入院和死亡风险很高。在从医院过渡到家庭的期间，没有标准的医疗服务提供方式，导致在优化护理方面错失机会。在本综述中，我们讨论了当代随机临床试验，这些试验测试了用于治疗病情恶化的心力衰竭患者的去充血策略、疾病改善疗法和医疗服务。我们提供基于证据的建议，以优化治疗方法并改善心力衰竭患者住院期间及出院后的治疗效果。这些建议包括使用袢利尿剂进行充分的去充血，并根据对利尿剂反应的早期评估选择序贯肾单位阻断策略；在出院前开始使用疾病改善药物治疗，并在出院后密切随访和优化；心脏康复；以及出院后转诊至过渡性或姑息性护理。促进广泛采用的基于证据的实施策略包括数字健康工具和药物治疗的算法驱动优化。
