真实世界中心力衰竭患者指南指导下的药物治疗快速滴定方案的可行性：一项多中心观察性研究

The Feasibility of a Guideline-Directed Medical Therapy Rapid Up-Titration Programme Among Real-World Heart Failure Patients: A Multicentre Observational Study.

作者信息

Bánfi-Bacsárdi Fanni, Ráduly Arnold Péter, Borbély Attila, Nyolczas Noémi, Szilágyi Attila, Gergely Tamás G, Forrai Zsolt, Papp Judit, Rátosi Orsolya, Rácz Tünde, Hati Krisztina, Kocsis Ildikó, Csanádi Zoltán, Duray Gábor Zoltán, Andréka Péter, Piróth Zsolt, Muk Balázs

机构信息

Department of Adult Cardiology, Gottsegen National Cardiovascular Center, 1096 Budapest, Hungary.

Doctoral School of Clinical Medicine, University of Szeged, 6720 Szeged, Hungary.

出版信息

J Clin Med. 2025 May 21;14(10):3611. doi: 10.3390/jcm14103611.

DOI:10.3390/jcm14103611

PMID:40429606

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12112513/

Abstract

The 2023 ESC Heart Failure (HF) Guidelines recommend the rapid up-titration of guideline-directed medical therapy (GDMT) for all patients after HF hospitalisation. Real-world data on the implementation of a rapid up-titration programme (RTP) are scarce. We aimed to summarise the primary experiences of a six-week RTP in a multicentre observational study of five cardiology centres, evaluating the GDMT applied and the target doses (TDs) achieved during the RTP. The safety of RTP in relation to exceeding the "safety indicators" used in the STRONG-HF trial and any serious adverse events were observed. Changes in the left ventricular ejection fraction (LVEF) after RTP were evaluated. Among the 90 consecutive patients (age: 56 [49-63] years, HFrEF: 96%, NT-proBNP at discharge: 1390 [735-2835] pg/mL; continuous variables are presented as median and interquartile ranges, while categorical variables are shown as absolute numbers and percentages, respectively), a remarkable proportion of patients received GDMT at hospital discharge; however, target doses were rarely achieved (RASi: 100%, TD RASi: 11%; βB: 97%, TD βB: 6%; MRA: 99%, TD MRA: 82%; SGLT2i: 98%, TD SGLT2i: 98%; triple therapy [TT: RASi + βB + MRA]: 96%, TD TT: 2%, quadruple therapy [QT: RASi + βB + MRA]: 94%, TD QT: 2%). After the six-week RTP, 100% of the total cohort (TC) were receiving RASi; 99-99-99% were receiving βB, MRA, and SGLT2i medications; and altogether, 98-98% were on TT and QT. In total, 78-78% of the patients received ≥50% of the TDs of TT and QT, while 51-51% of the TC were on TDs of TT and QT. During the RTP, no serious adverse events were observed. Between two and four months after the RTP, 51% of HFrEF patients evolved to the HFimpEF category. The present multicentre, observational study confirms that RTP is feasible and safe in real-world clinical practice, leading to a remarkably large proportion of patients receiving GDMT by the end of the six-week RTP, resulting in a significant increase in LVEF.

摘要

2023年欧洲心脏病学会（ESC）心力衰竭（HF）指南建议，所有HF住院患者出院后应迅速增加指南导向的药物治疗（GDMT）剂量。关于实施快速滴定方案（RTP）的真实世界数据很少。我们旨在总结一项在五个心脏病中心进行的多中心观察性研究中为期六周的RTP的主要经验，评估RTP期间应用的GDMT和达到的目标剂量（TDs）。观察了RTP相对于STRONG-HF试验中使用的“安全指标”超标以及任何严重不良事件的安全性。评估了RTP后左心室射血分数（LVEF）的变化。在连续纳入的90例患者中（年龄：56[49-63]岁，射血分数降低的HF[HFrEF]：96%，出院时N末端B型利钠肽原[NT-proBNP]：1390[735-2835]pg/mL；连续变量以中位数和四分位间距表示，分类变量分别以绝对数和百分比表示），相当一部分患者出院时接受了GDMT；然而，很少达到目标剂量（肾素-血管紧张素系统抑制剂[RASi]：100%，RASi目标剂量：11%；β受体阻滞剂[βB]：97%，βB目标剂量：6%；醛固酮受体拮抗剂[MRA]：99%，MRA目标剂量：82%；钠-葡萄糖协同转运蛋白2抑制剂[SGLT2i]：98%，SGLT2i目标剂量：98%；三联疗法[TT：RASi+βB+MRA]：96%，TT目标剂量：2%，四联疗法[QT：RASi+βB+MRA]：94%，QT目标剂量：2%）。六周的RTP后，整个队列（TC）的100%接受RASi治疗；99%-99%-99%接受βB、MRA和SGLT2i药物治疗；总体而言，98%-98%接受TT和QT治疗。总共有78%-78%的患者接受了≥50%的TT和QT目标剂量，而51%-51%的TC接受了TT和QT的目标剂量。在RTP期间，未观察到严重不良事件。在RTP后两到四个月之间，51%的HFrEF患者进展为射血分数改善的HF（HFimpEF）类别。本多中心观察性研究证实，RTP在真实世界临床实践中是可行且安全的，导致在六周RTP结束时相当大比例的患者接受了GDMT，从而使LVEF显著增加。