慢性心衰患者指南导向药物治疗应用调查分析

Investigation and analysis of guideline-directed medical therapy in patients with chronic heart failure

目的分析苏州科技城医院慢性心衰患者指南导向药物治疗的应用现状。方法收集分析2021年6月至2022年5月慢性心衰患者抗心衰药物“新四联”和“金三角”方案的使用情况和“新四联”抗心衰药物剂量达标情况。结果235例慢性心衰患者中,血管紧张素受体脑啡肽酶抑制剂(ARNI)/血管紧张素转换酶抑制剂(ACEI)/血管紧张素II受体阻滞剂(ARB)使用比例最高(76.96%),其中,ARNI占78.53%;β受体阻滞剂(BB)、盐皮质激素受体拮抗剂(MRA)和钠-葡萄糖协同转运蛋白2抑制剂(SGLT2i)的使用比例分别为69.36%、51.06%和20.00%。在射血分数降低的心力衰竭(HFrEF)患者中,使用“新四联”的患者占14.29%,使用“金三角”的患者占60.71%。其中,“新金三角”患者占全部“金三角”患者的94.12%。射血分数中间值的心衰(HFmrEF)和射血分数保留的心衰(HFpEF)患者中使用ARNI/ACEI/ARB+BB±MRA±SGLT2i的比例分别为64.86%和40.59%。4类抗心衰药物中,螺内酯目标靶剂量100%达标,SGLT2i目标靶剂量达标比例为97.87%,β受体阻滞剂和ARNI均未达到目标靶剂量。结论慢性心衰患者的药物治疗方案和指南导向药物治疗相比仍有较大差距,尤其是HFrEF患者在“新四联”方案的选用和药物剂量滴定方面仍有较大提升空间。

Objective To analyze the application of guideline-directed medical therapy in patients with chronic heart failure in Suzhou Science and Technology Town Hospital.Methods The application data of“new quadruple therapy”and“golden triangle”regimens and the standard-reaching of“new quadruple therapy”regimen in patients with chronic heart failure from June 2021 to May 2022 were collected and analyzed.Results Among 235 patients with chronic heart failure,the proportion of using angiotensin receptor neprilysin inhibitor(ARNI)/angiotensin converting enzyme inhibitor(ACEI)/angiotensin II receptor blocker(ARB)was the highest(76.96%),in which ARNI accounted for 78.53%.The proportion of usingβ-blocker(BB),mineralocorticoid receptor antagonist(MRA)and sodium-glucose cotransporter-2 inhibitors(SGLT2i)was 69.36%,51.06%and 20.00%,respectively.In patients with heart failure with reduced ejection fraction(HFrEF),only 14.29%used the“new quadruple therapy”regimen,while 60.71%used the“golden triangle”regimen.Among the patients using“golden triangle”regimen,94.12%used the“new golden triangle”.The proportion of using ARNI/ACEI/ARB+BB±MRA±SGLT2i in patients with heart failure with mildly reduced ejection fraction(HFmrEF)or heart failure with preserved ejection fraction(HFpEF)was 64.86%and 40.59%,respectively.Among the 4 types of anti-heart failure drugs,the rates of dosage which reached the target dose of spironolactone and SGLT2i were 100%and 97.87%,respectively.Neitherβ-blocker nor ARNI reached the target dose.Conclusion There is still a big gap between the medical treatment regimen in our hospital and the guideline-directed medical therapy for patients with chronic heart failure,especially for HFrEF patients,there is still large room for improvement in the selection of the“new quadruple therapy”and dose titration.