Christodorescu Ruxandra Maria, Brie Daniel Miron, Brie Alina Diduța, Mornoș Cristian, Drăgan Simona Ruxandra, Luca Constantin Tudor, Dărăbanțiu Dan, Tîrziu Alexandru
Department of Internal Medicine, "Victor Babes" University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania.
Research Center of the Institute of Cardiovascular Diseases, Gheorghe Adam St., No. 13A, 300310 Timisoara, Romania.
J Clin Med. 2025 Apr 13;14(8):2664. doi: 10.3390/jcm14082664.
Current guidelines emphasize the importance of initiating or optimizing the four pillars of heart failure with reduced ejection fraction (HFrEF) therapy-beta-blockers (BB), mineralocorticoid receptor antagonists (MRA), angiotensin receptor-neprilysin inhibitors (ARNI), and sodium-glucose cotransporter-2 inhibitors (SGLT2i)-during hospitalization for acute decompensation. This study compares clinical characteristics and outcomes in HFrEF patients hospitalized for decompensated heart failure based on whether they were newly initiated on or were already receiving at least one of these four pillars. This prospective observational study included 203 HFrEF patients hospitalized for acute decompensation. Patients were divided into two groups: Group A ( = 126), not receiving any of the four pillars prior to admission, and Group B ( = 77), receiving at least one. Clinical and biological parameters were evaluated during hospitalization, with outcomes including changes in weight, blood pressure, heart rate, renal function (serum creatinine), electrolyte levels (sodium, potassium), and 30-day mortality. Statistical analyses included the non-parametric Mann-Whitney test and Chi-squared test. Baseline characteristics (age, gender, LVEF, NT-proBNP) were similar between the two groups. No significant difference was observed in 30-day mortality (Group A: 7.14%, Group B: 5.55%, = 0.74). Both groups experienced significant improvements in systolic and diastolic blood pressure and heart rate during hospitalization ( < 0.05). While serum creatinine levels remained stable in both groups, creatinine dynamics (Δcreatinine) were significantly different ( = 0.02), with Group B exhibiting a higher increase. The improvement in ejection fraction was more pronounced in Group A ( = 0.057) compared to Group B. Both groups demonstrated significant improvements in NYHA functional class ( < 0.001). In Group B, the use of MRAs and SGLT2 inhibitors significantly increased during hospitalization ( = 0.01 and < 0.001, respectively). The initiation or optimization of the four pillars of HFrEF therapy during hospitalization for acute decompensation is feasible and well-tolerated. Early intervention leads to improvements in clinical parameters and functional status, supporting guideline recommendations for in-hospital initiation or optimization of HFrEF therapy. Special consideration should be given to renal function when optimizing therapy.
当前指南强调，在急性失代偿住院期间启动或优化射血分数降低的心力衰竭（HFrEF）治疗的四大支柱药物——β受体阻滞剂（BB）、盐皮质激素受体拮抗剂（MRA）、血管紧张素受体脑啡肽酶抑制剂（ARNI）和钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）——的重要性。本研究比较了因失代偿性心力衰竭住院的HFrEF患者的临床特征和预后，这些患者基于是否新启动或已接受这四大支柱药物中的至少一种进行分组。这项前瞻性观察性研究纳入了203例因急性失代偿住院的HFrEF患者。患者被分为两组：A组（n = 126），入院前未接受任何一种四大支柱药物治疗；B组（n = 77），接受至少一种治疗。住院期间评估了临床和生物学参数，预后指标包括体重、血压、心率、肾功能（血清肌酐）、电解质水平（钠、钾）的变化以及30天死亡率。统计分析包括非参数Mann-Whitney检验和卡方检验。两组的基线特征（年龄、性别、左室射血分数、N末端脑钠肽前体）相似。30天死亡率无显著差异（A组：7.14%，B组：5.55%，P = 0.74）。两组在住院期间收缩压、舒张压和心率均有显著改善（P < 0.05）。虽然两组血清肌酐水平均保持稳定，但肌酐变化量（Δ肌酐）有显著差异（P = 0.02），B组升高幅度更大。A组射血分数的改善比B组更明显（P = 0.057）。两组纽约心脏协会（NYHA）心功能分级均有显著改善（P < 0.001）。在B组，住院期间MRA和SGLT2抑制剂的使用显著增加（分别为P = 0.01和P < 0.001）。在急性失代偿住院期间启动或优化HFrEF治疗的四大支柱药物是可行的，且耐受性良好。早期干预可改善临床参数和功能状态，支持在院内启动或优化HFrEF治疗的指南推荐。在优化治疗时应特别考虑肾功能。
