Shahim Angiza, Linde Cecilia, Savarese Gianluigi, Dahlström Ulf, Lund Lars H, Hage Camilla
Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
Heart and Vascular and Neurology Theme, Karolinska University Hospital, Stockholm, Sweden.
Eur J Heart Fail. 2025 Mar;27(3):421-431. doi: 10.1002/ejhf.3565. Epub 2025 Jan 9.
Guidelines recommend immediate initiation of all four class I guideline-directed medical therapies, renin-angiotensin system inhibitors (RASI) or angiotensin receptor-neprilysin inhibitors (ARNI), beta-blockers, mineralocorticoid receptor antagonists (MRA) and sodium-glucose cotransporter 2 inhibitors (SGLT2i) following the diagnosis of heart failure (HF) with reduced ejection fraction (HFrEF). The extent to which this occurs in new-onset HFrEF is unclear. We assessed guideline-recommended therapies during the first year following a HFrEF diagnosis.
The Swedish HF Registry was linked to additional national registries. In patients with HFrEF (ejection fraction <40%), clinical characteristics and HF treatment from when they were available and recommended in guidelines were assessed according to time from HF diagnosis (<3, 3 to <6, 6-12 and >12 months). Of 55 581 patients with HFrEF enrolled between 2000 and 2021, 54%, 5.8%, 4.8% and 36% had an HF duration of <3, 3 to <6, 6-12 and >12 months, respectively. Patients with shorter HF duration were younger, had lower New York Heart Association class and had fewer cardiovascular comorbidities. Within 3 months, 3 to <6 months, 6-12 months and >12 months from HF diagnosis, 93%, 92%, 90% and 89% were on RASI or ARNI, 9.8%, 17%, 19% and 22% on ARNI alone, 35%, 43%, 44% and 46% on MRA, 92%, 92%, 92% and 91% on beta-blockers, and 26%, 30%, 19% and 28% on SGLT2i, respectively. Additionally, 18% received cardiac resynchronization therapy/implantable cardioverter-defibrillator >12 months after diagnosis.
Most patients received RASI and beta-blockers in the first months following HFrEF diagnosis. Use of ARNI, MRA and SGLT2i was limited, both in the early and later time periods. Our findings suggest that strategies to improve guideline-directed use of HFrEF therapies remain urgently needed.
指南建议在射血分数降低的心力衰竭（HFrEF）诊断后立即启动所有四种I类指南指导的药物治疗，即肾素-血管紧张素系统抑制剂（RASI）或血管紧张素受体脑啡肽酶抑制剂（ARNI）、β受体阻滞剂、盐皮质激素受体拮抗剂（MRA）和钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）。在新发HFrEF中这种情况的发生程度尚不清楚。我们评估了HFrEF诊断后第一年中指南推荐的治疗方法。
瑞典心力衰竭登记处与其他国家登记处相关联。在HFrEF患者（射血分数<40%）中，根据自心力衰竭诊断后的时间（<3个月、3至<6个月、6 - 12个月和>12个月）评估临床特征和自指南中可用并推荐时起的心力衰竭治疗情况。在2000年至2021年登记的55581例HFrEF患者中，心力衰竭病程<3个月、3至<6个月、6 - 12个月和>12个月的患者分别占54%、5.8%、4.8%和36%。心力衰竭病程较短的患者更年轻，纽约心脏协会分级更低，心血管合并症更少。在心力衰竭诊断后的3个月内、3至<6个月、6 - 12个月和>12个月时，分别有93%、92%、90%和89%的患者使用RASI或ARNI，仅使用ARNI的患者分别占9.8%、17%、19%和22%，使用MRA的患者分别占35%、43%、44%和46%，使用β受体阻滞剂的患者分别占92%、92%、92%和91%，使用SGLT2i的患者分别占
