Saveski Dimitar, Kok Melanie, Poon Stephanie, Rojas-Fernandez Carlos, Virani Sean A, Honos George, McKelvie Robert
St Joseph's Health Care, Western University, London, Ontario, Canada.
Novartis Pharmaceuticals Canada Inc., Montreal, Quebec, Canada.
CJC Open. 2024 Oct 9;7(1):1-9. doi: 10.1016/j.cjco.2024.09.014. eCollection 2025 Jan.
Guideline-directed medical therapy (GDMT) reduces events in patients with heart failure (HF) with reduced ejection fraction (HFrEF). Despite this impact, underutilization of GDMT persists. This report sought to describe HF management in Canadian outpatients treated at specialized HF clinics (HFCs).
The Canadian Heart Failure (CAN-HF) study was retrospective and observational, and it included 1775 patients from 6 Canadian outpatient HFCs, from the period January 2017-April 2020.
We observed improvement in prescription rates in patients with HFrEF, between their first visit and their most-recent clinic visit, across all GDMT classes, in those who were followed at the HFC for ≥ 6 months. The largest prescription rate increases were observed for angiotensin receptor-neprilysin inhibitors and mineralocorticoid-receptor antagonists. However, more than half of the patients remained on angiotensin-converting enzyme inhibitors and/or angiotensin-receptor blockers, despite being symptomatic, according to their New York Heart Association class. Most patients (50%) were on triple therapy, as of their most-recent visit, with fewer (36%) on dual therapy, monotherapy (13%), or no GDMT (2%). Our data also suggest that patients who had been managed at the HFC for > 6 months had higher prescription rates of GDMT and were on higher doses of GDMT, compared to those who were new to the clinic. For patients with HF with preserved ejection fraction, few patients were on candesartan and less than half were on a mineralocorticoid-receptor antagonist.
Our data from HFCs that in most cases were affiliated with academic centres compare favourably with data from other analyses of ambulatory patients with HFrEF, evidence that supports the use of a specialized patient-care model.
指南指导的药物治疗（GDMT）可减少射血分数降低的心力衰竭（HFrEF）患者的事件发生。尽管有此作用，但GDMT的利用不足情况仍然存在。本报告旨在描述在加拿大专门的心力衰竭诊所（HFC）接受治疗的门诊患者的心力衰竭管理情况。
加拿大心力衰竭（CAN-HF）研究是一项回顾性观察性研究，纳入了2017年1月至2020年4月期间来自加拿大6家门诊HFC的1775例患者。
我们观察到，在HFC随访≥6个月的HFrEF患者中，从首次就诊到最近一次诊所就诊，所有GDMT类别药物的处方率均有所提高。血管紧张素受体脑啡肽酶抑制剂和盐皮质激素受体拮抗剂的处方率增幅最大。然而，超过一半的患者尽管有症状（根据纽约心脏协会分级），仍继续使用血管紧张素转换酶抑制剂和/或血管紧张素受体阻滞剂。截至最近一次就诊，大多数患者（50%）接受三联疗法，接受双联疗法的患者较少（36%），接受单药治疗的患者较少（13%），未接受GDMT治疗的患者较少（2%）。我们的数据还表明，与新到诊所的患者相比，在HFC接受管理超过6个月的患者GDMT处方率更高，且使用的GDMT剂量更高。对于射血分数保留的心力衰竭患者，很少有患者使用坎地沙坦，不到一半的患者使用盐皮质激素受体拮抗剂。
我们来自大多数情况下与学术中心相关的HFC的数据，与其他对HFrEF门诊患者的分析数据相比具有优势，这一证据支持使用专门的患者护理模式。
