“稳定”心力衰竭患者:正确的时机

Q4 Medicine
Carlos de Diego , Julio Núñez
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引用次数: 0

摘要

PARADIGM-HF临床试验和其他针对射血分数降低(HFrEF)心力衰竭患者的关键研究数据显示,那些被描述为“稳定”的患者(即纽约心脏协会(NYHA)功能II类患者中的大多数,近期没有因心力衰竭入院)实际上具有非常差的临床预后:他们因心力衰竭入院的比例很高,在接下来的3年内心血管死亡率为25%。此外,大多数猝死的HFrEF患者并没有经历功能能力的显著恶化。因此,这种“临床稳定性的错误印象”并不意味着预后良好或没有疾病进展。在PARADIGM-HF研究中,大多数稳定的NYHA功能II级患者与依那普利相比,使用苏比替-缬沙坦治疗可显著降低因心力衰竭而死亡或住院的风险。值得注意的是,猝死的风险也显著降低。传统上,植入式心律转复除颤器(ICDs)是降低这些患者猝死风险的最有效方法。然而,它们并不能100%预防这些死亡,高达50%的icd患者通过各种机制猝死。这说明了为什么我们应该在稳定的临床阶段加强医疗,因为这是可以获得最大量可靠科学证据的情况。因此,一旦患者被诊断为HFrEF,就必须完全根据证据采取行动,而不是等待下一次失代偿。治疗惰性和拖延行动,直到临床恶化明显,只会导致“绝望的经验主义”。然而,在常规临床实践中,即使在共识指南中建议使用苏比替-缬沙坦等药物,其吸收率仍然相对较低,这无疑令人深思。补充信息:本文是由诺华赞助的题为“关于心力衰竭治疗新时代的问题”的补充的一部分
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Paciente «estable» con insuficiencia cardiaca: el momento oportuno

Data from the PARADIGM-HF clinical trial and other key studies in patients with heart failure with a reduced ejection fraction (HFrEF) show that those described as "stable" (i.e. the majority in New York Heart Association [NYHA] functional class II with no recent admission for heart failure) actually have a very poor clinical prognosis: they have a high rate of admission for heart failure and a cardiovascular mortality of 25% in the following 3 years. Moreover, most patients with HFrEF who suffer sudden death did not experience a significant deterioration in functional capacity. This "false impression of clinical stability", therefore, does not imply a good prognosis or the absence of disease progression.

In the PARADIGM-HF study, which included mostly stable patients in NYHA functional class II, treatment with sacubitril-valsartan significantly reduced the risk of death or hospitalization due to heart failure compared with enalapril. Remarkably, the risk of sudden death was also decreased significantly. Traditionally, implantable cardioverter-defibrillators (ICDs) provide the most effective way of reducing the risk of sudden death in these patients. However, they do not prevent 100% of these deaths and up to 50% of patients with ICDs experience sudden death via various mechanisms. This illustrates why we should strengthen medical treatment during the stable clinical phase, which is the scenario for which the greatest amount of solid scientific evidence is available. Once a patient has been diagnosed with HFrEF, therefore, it is essential to act in full accordance with the evidence without waiting for the next decompensation. Therapeutic inertia and delaying action until clinical deterioration is evident will only result in a "desperate empiricism". Nevertheless, the uptake of drugs such as sacubitril-valsartan in routine clinical practice is still relatively low even when their use is indicated by consensus guidelines, which undoubtedly gives pause for thought.

Supplement information: this article is part of a supplement entitled "Questions on a new era for heart failure treatment" which is sponsored by Novartis

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来源期刊
Revista Espanola de Cardiologia Suplementos
Revista Espanola de Cardiologia Suplementos Medicine-Cardiology and Cardiovascular Medicine
CiteScore
1.20
自引率
0.00%
发文量
1
期刊介绍: Revista Española de Cardiología, is an international scientific journal dealing with cardiovascular medicine. Revista Española de Cardiología, the official publication of the Spanish Society of Cardiology, publishes research articles related to cardiovascular diseases. Articles are published in Spanish for the paper edition and in both Spanish and English in the electronic edition, which is available on the Internet. Regular sections include original articles reporting clinical or basic research, brief reports, review articles, editorials and letters to the Editor.
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