Clarkson Stephen A, Lund Lars H, Mebazaa Alexandre
Department of Internal Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Tinsley Harrison Tower, Suite 311, 1900 University Boulevard, Birmingham, AL, 35233, USA.
Department of Medicine, Karolinska University Hospital, Stockholm, Sweden.
Heart Fail Rev. 2025 May;30(3):537-543. doi: 10.1007/s10741-025-10486-2. Epub 2025 Jan 24.
Heart failure (HF), a chronic and progressive disease, is increasing in prevalence worldwide and is associated with increased hospitalizations and death. Despite notable improvements in medical therapy for HF, patients are still at risk of future negative outcomes. Current guidelines recommend four classes of medication for treating patients with HF, deemed guideline-directed medical therapy (GDMT). The use and adherence of these GDMTs serve as a major predictor of outcomes in those with chronic HF; however, implementation of therapy remains poor, despite substantial evidence of benefit. The acute hospitalization for HF and the subsequent vulnerable period serve as important milestones for adequate disease modification, and implementing a strategy for aggressive medical therapy can improve HF outcomes. Current guidelines also recommend that follow-up with multidisciplinary chronic disease management specific to HF be provided to those living with heart failure, which is essential for improving readmissions and mortality. This follow-up, although important by itself, serves as an important avenue for disease modification through medication titration, and implementing such structured follow-up is essential for further population-wide improvements in HF mortality. In this context, the STRONG-HF trial investigators developed an implementation trial providing evidence for the rapid inpatient initiation and subsequent titration of HF GDMT, demonstrating the importance of implementation strategies in the care of HF patients. In this narrative review, we review the evidence base for treating patients with HF, highlight deficits in our current real-world experience, and provide support for trial evidence like STRONG-HF in the global fight to reduce the burden of HF.
心力衰竭（HF）是一种慢性进行性疾病，在全球范围内的患病率不断上升，且与住院率和死亡率增加相关。尽管HF的药物治疗有显著改善，但患者仍面临未来不良结局的风险。当前指南推荐四类药物用于治疗HF患者，即所谓的指南导向药物治疗（GDMT）。这些GDMT的使用和依从性是慢性HF患者预后的主要预测指标；然而，尽管有大量获益证据，治疗的实施情况仍然不佳。HF急性住院及随后的脆弱期是进行充分疾病改善的重要节点，实施积极药物治疗策略可改善HF预后。当前指南还建议为心力衰竭患者提供针对HF的多学科慢性病管理随访，这对于减少再入院率和死亡率至关重要。这种随访本身虽然很重要，但也是通过药物滴定进行疾病改善的重要途径，实施这种结构化随访对于进一步在全人群中降低HF死亡率至关重要。在此背景下，STRONG-HF试验研究者开展了一项实施试验，为HF GDMT在住院期间快速启动及随后的滴定提供了证据，证明了实施策略在HF患者护理中的重要性。在这篇叙述性综述中，我们回顾了治疗HF患者的证据基础，强调了我们当前实际经验中的不足，并为STRONG-HF等试验证据提供支持，以助力全球减轻HF负担的斗争。
