Hiremath Jagdish, Routray S N, Hazra Prakash, Gandotra Dheeraj, Ponde C K, Pandey Bijay P, Unni Govindan, Sharma Rajat, Shivkadaksham Natarajan, Sathe Sunil, Makhale Chandrashekhar, Kumar Nikhil
Cardiology, Ruby Hall Clinic, Pune, IND.
Cardiology, SCB (Srirama Chandra Bhanja) Medical College and Hospital, Cuttack, IND.
Cureus. 2024 Nov 6;16(11):e73175. doi: 10.7759/cureus.73175. eCollection 2024 Nov.
Home time, defined as time spent by the patient alive and out of any healthcare institution, is an important patient-centric outcome for patients with cardiovascular disease. Home time is recognized as a crucial measure of recovery post cardiovascular events but has not been extensively studied in heart failure (HF) patients, especially in India. HF in India is rapidly growing at an epidemic scale and hence the focus on improving home time in HF patients highlights the need for precise, patient-centered care strategies. Current literature lacks detailed descriptions of hospital-level patterns and predictors of home time in contemporary HF populations, which hinders tailored approaches to optimize outcomes like functional status and health-related quality of life along with reduced hospitalization and mortality risks. Literature is abundant with clinical evidence on the benefits of guideline-directed medical therapy (GDMT), especially angiotensin receptor neprilysin inhibitor (ARNI) therapy, in HF management. All major guidelines highly recommend its initiation for reducing morbidity and mortality in patients with chronic symptomatic HF with reduced ejection fraction. Studies indicate that sacubitril/valsartan, the first in class of ARNI, improves the quality of life and functional outcomes, along with reduced HF-related hospitalizations and cardiovascular deaths. Its unique mechanism of action, combining neprilysin inhibition and angiotensin receptor blockade, targets multiple pathways of HF pathophysiology, leading to improved cardiac function and remodeling. These benefits are pivotal in supporting patients' ability to maintain an active lifestyle outside of healthcare settings. Despite its demonstrated benefits, sacubitril/valsartan is underutilized. Integrating sacubitril/valsartan more optimally into clinical practice could significantly alleviate the overall burden of HF by addressing key determinants of home time and improving patient outcomes post discharge.
居家时间，定义为患者存活且不在任何医疗机构的时间，是心血管疾病患者以患者为中心的一项重要预后指标。居家时间被认为是心血管事件后恢复情况的关键衡量指标，但在心力衰竭（HF）患者中尚未得到广泛研究，尤其是在印度。印度的心力衰竭病例呈流行趋势快速增长，因此关注改善心力衰竭患者的居家时间凸显了制定精准、以患者为中心的护理策略的必要性。当前文献缺乏对当代心力衰竭患者群体在医院层面的居家时间模式及预测因素的详细描述，这阻碍了为优化诸如功能状态和健康相关生活质量等预后指标而采取的针对性方法，同时也不利于降低住院率和死亡率风险。关于指南指导的药物治疗（GDMT），尤其是血管紧张素受体脑啡肽酶抑制剂（ARNI）治疗在心力衰竭管理中的益处，已有大量临床证据。所有主要指南都强烈推荐在射血分数降低的慢性症状性心力衰竭患者中启动此类治疗，以降低发病率和死亡率。研究表明，ARNI类药物中的首个药物沙库巴曲缬沙坦可改善生活质量和功能预后，同时减少与心力衰竭相关的住院率和心血管死亡。其独特的作用机制，即结合了脑啡肽酶抑制和血管紧张素受体阻断作用，针对心力衰竭病理生理学的多个途径，从而改善心脏功能和重塑。这些益处对于支持患者在医疗机构之外保持积极生活方式的能力至关重要。尽管沙库巴曲缬沙坦已证实具有益处，但仍未得到充分利用。更优化地将沙库巴曲缬沙坦纳入临床实践，通过解决居家时间的关键决定因素并改善出院后患者的预后，可显著减轻心力衰竭的总体负担。
