Vu Hoang Vu, Bui The Dung, Do Hai An, Pham Dang Duy Quang, Truong Quang Binh
Interventional Cardiology Department, University Medical Center Ho Chi Minh City, Ho Chi Minh City, Vietnam.
Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.
BMC Cardiovasc Disord. 2025 Jul 14;25(1):506. doi: 10.1186/s12872-025-04964-6.
Although guideline-directed medical therapy (GDMT) improves outcomes in patients with heart failure with reduced ejection fraction (HFrEF), multiple real-world studies - such as CHAMP-HF (USA) and ASIAN-HF (Asia-Pacific) - have reported that a large proportion of patients fail to reach target doses. This global gap between recommendations and practice highlights the need to better understand country-specific barriers, particularly in low- and middle-income settings such as Vietnam.
This cross-sectional study included adult outpatients diagnosed with HFrEF who had received at least three months of continuous therapy at the Heart Failure Clinic, University Medical Center Ho Chi Minh City, between February and August 2023, and aimed to (1) determine the prevalence of use, (2) evaluate typical dosages, and (3) examine the sequence of initiation of foundational therapies in this population.
Among 181 patients, 98.9% were prescribed at least one foundational drug class, and 74.6% received all four classes. Patients who did not receive all four therapies were typically older females with higher systolic blood pressure and reduced renal function. SGLT2 inhibitors and MRAs had the highest rates of target dose achievement, whereas ARNI and beta-blockers were more frequently underdosed. Dose escalation was commonly limited by hypotension, advanced age, renal impairment, and low body weight. Notably, 82% of patients were initiated on three or four drug classes concurrently at the start of treatment, most commonly including RAS inhibitors, MRAs, and beta-blockers, with a preference for ARNI over ACE inhibitors or ARBs.
Foundational therapies were widely prescribed and frequently initiated concurrently in the management of HFrEF at a tertiary care hospital in Vietnam. However, achieving target doses remains a challenge, highlighting the gap between clinical guidelines and real-world practice due to factors such as low blood pressure, advanced age, and renal dysfunction.
尽管基于指南的药物治疗（GDMT）可改善射血分数降低的心力衰竭（HFrEF）患者的预后，但多项真实世界研究——如CHAMP-HF（美国）和ASIAN-HF（亚太地区）——报告称，很大一部分患者未能达到目标剂量。建议与实践之间的这种全球差距凸显了更好地了解特定国家障碍的必要性，尤其是在越南等低收入和中等收入地区。
这项横断面研究纳入了2023年2月至8月期间在胡志明市大学医学中心心力衰竭诊所接受至少三个月持续治疗的成年门诊HFrEF患者，旨在（1）确定药物使用的患病率，（2）评估典型剂量，以及（3）检查该人群中基础治疗的起始顺序。
在181例患者中，98.9%的患者至少被处方了一种基础药物类别，74.6%的患者接受了所有四类药物。未接受全部四种治疗的患者通常为老年女性，收缩压较高且肾功能减退。钠-葡萄糖协同转运蛋白2（SGLT2）抑制剂和醛固酮受体拮抗剂（MRA）达到目标剂量的比例最高，而血管紧张素受体脑啡肽酶抑制剂（ARNI）和β受体阻滞剂的剂量不足更为常见。剂量递增通常受低血压、高龄、肾功能损害和低体重的限制。值得注意的是，82%的患者在治疗开始时同时启动了三种或四种药物类别，最常见的包括肾素-血管紧张素系统（RAS）抑制剂、MRA和β受体阻滞剂，相较于血管紧张素转换酶（ACE）抑制剂或血管紧张素Ⅱ受体阻滞剂（ARB），更倾向于使用ARNI。
在越南一家三级医院对HFrEF的管理中，基础治疗被广泛处方且经常同时启动。然而，达到目标剂量仍然是一项挑战，这凸显了由于低血压、高龄和肾功能不全等因素导致的临床指南与真实世界实践之间的差距。
