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首页> 外文期刊>Journal of cardiac failure >Guideline-Directed Medical Therapy in Hospitalized Heart Failure Patients: Still Underprescribed Despite Updated Guidelines and Over 20 Years of Evidence
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Guideline-Directed Medical Therapy in Hospitalized Heart Failure Patients: Still Underprescribed Despite Updated Guidelines and Over 20 Years of Evidence

机译：治疗心力衰竭患者的指南医疗疗法：尽管更新了准则和超过20年的证据，但仍处于欠款

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BackgroundHeart failure (HF) is a progressive condition and repeated hospitalizations are associated with worse outcomes. Guideline-directed medical therapy (GDMT) is proven to reduce morbidity and mortality however previous literature has demonstrated low rates of prescribing. In April 2017, the ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guidelines for the Management of Heart Failure provided a clarified recommendation supporting the clinical strategy of renin-angiotensin system inhibition through angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs) or angiotensin receptor-neprilysin inhibitors (ARNIs) in conjunction with evidence-based beta blockers and aldosterone antagonists in select heart failure with reduced ejection fraction (HFrEF) patients. We aimed to evaluate prescriber adherence rates to GDMT in patients hospitalized with acute decompensated heart failure (ADHF) at time of discharge after the publication of the guideline update. MethodsA retrospective chart review of HF admissions at a large urban academic health system was conducted between October 1, 2017 and December 31, 2017. Patients 18 years or older with a left ventricular ejection fraction of 40 percent or less were included. Patients were excluded if they had a left ventricular assist device, heart transplant, end-stage renal disease on hemodialysis or were dependent on inotropes. Criteria for appropriate GDMT use were developed to guide data collection based off the 2017 ACC/AHA/HFSA Focused Update. The primary outcome was prescriber adherence to GDMT determined by prescriptions written at the time of discharge or documented on the discharge summary. Secondary outcomes included 30-day all-cause readmission rate and guideline adherence by provider service. ResultsOf the 50 patients reviewed only 32% (n=16) were discharged on appropriate GDMT. depicts the percent of eligible patients receiving therapy upon discharge by drug class. Guideline adherence among the internal medicine service was 33.3% (12/36) compared to 28.5% (4/14) among the cardiology service. The 30-day readmission rate was lower among those discharged on appropriate therapy versus inappropriate therapy (25% vs. 46%). ConclusionDespite over 20 years of evidence and recently published guideline updates our results demonstrate poor prescriber adherence to GDMT with an alarmingly low number of eligible patients receiving aldosterone antagonists and appropriate combination therapy. Health systems must recognize and address barriers to guideline adherence in order to improve outcomes for HF patients.
机译：Backgroundheart失败（HF）是一种渐进状态，重复住院治疗与更严重的结果有关。指导指导的医疗疗法（GDMT）被证明是降低发病率和死亡率，但之前的文献已经表现出低的处方率。 2017年4月，ACC / AHA / HFSA的重点更新2013年ACCF / AHA管理指南的心力衰竭指南提供了一种澄清的建议，提供了通过血管紧张素转换酶抑制剂（Aceis），血管紧张素的血管素转换酶抑制剂的临床策略受体阻滞剂（ARB）或血管紧张素受体 - 内胚抑制剂（ARNIS）与基于循证β受体阻滞剂和醛固酮拮抗剂的选择心力衰竭与减少的喷射部分（HFREF）患者结合。我们的旨在在出版指南更新后，在出院时评估住院的患者的患者患者患者的争夺诉讼率为GDMT。 MethaSA在2017年10月1日至2017年10月1日至2017年12月31日之间进行了大型城市学术卫生系统HF招生的回顾图。如果患者患有左心室辅助装置，心脏移植，血液透析末期肾脏疾病，或依赖于肉质症。开发了适当GDMT使用的标准，以便根据2017年ACC / AHA / HFSA重点更新指导数据收集。主要结果是通过在排放时间或记录在排放摘要上写入的处方确定的GDMT的售前遵守。二次结果包括供应商服务30天的全面入院率和准则遵守。结果50名患者仅在适当的GDMT上审查了32％（n = 16）。描绘了药物课程出院后接受治疗的符合条件患者的百分比。内部医学服务中的准则依从性为33.3％（12/36），而心理学服务中的28.5％（4/14）。在适当治疗的那些对30天的入院率降低，与不适当的治疗（25％对46％）。结束人数超过20年的证据和最近公布的指南更新我们的结果展示了令人难度的处方遵守GDMT，少数少数少数少数患者接受醛固酮拮抗剂和适当的联合治疗。卫生系统必须识别并解决准则遵守的障碍，以改善患有HF患者的结果。

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