摘要
目的探讨沙库巴曲缬沙坦(ARNI)在射血分数降低的心力衰竭(HFrEF)患者中的真实世界实际使用情况。方法对254例使用ARNI的HFrEF患者进行6个月随访,根据随访时ARNI用量情况分为维持剂量组(n=148)、剂量增加组(n=37)、剂量减少或撤药组(n=69)。比较3组患者治疗前后的用药剂量情况、超声心动图参数、收缩压、实验室检查水平,分析影响ARNI滴定的相关因素。结果5.1%的患者滴定至靶剂量。治疗6个月后,维持剂量组、剂量增加组的左室射血分数均较治疗前显著提高(△=7.6%、12.1%,P<0.01),收缩压显著降低(△=-16.4 mmHg、-7.6 mmHg,P<0.05)。多因素Logistic回归分析显示,再住院(OR=3.89,95%CI为1.66~9.13,P<0.01)是ARNI剂量滴定的独立预测因子。结论大部分使用ARNI患者维持在低于靶剂量水平,心功能虽然得到明显改善,但仍错失可增加药物滴定的机会,并未最佳获益。目前ARNI滴定往往通过再住院实现,因此需加强心衰患者的教育和随访管理。
Objective To explore the real-world prescription and treatment patterns of sacubitril/valsartan(ARNI)in heart failure patients with reduced ejection fraction(HFrEF).Methods A total of 254 consecutive patients diagnosed as HFrEF and treated by ARNI were followed up for 6 months.According to the amount of ARNI during follow-up,the patients were divided into maintenance dose group(n=148),dose increase group(n=37)and dose reduction or withdrawal group(n=69).The dosage,echocardiographic parameters,systolic blood pressure and laboratory test level of three groups were compared before and after treatment,and the related influencing factors for ARNI titration were analyzed.Results 5.1%of patients titrated to the target dose.After 6 months of treatment,the left ventricular ejection fraction(LVEF)in the maintenance dose group and the dose increase group was significantly higher than that before treatment(△=7.6%,12.1%,P<0.01),and systolic blood pressure significantly reduced than those before treatment(△=-16.4 mmHg,-7.6 mmHg,P<0.05).Multivariate Logistic regression analysis showed that readmission(OR=3.89,95%CI=1.66~9.13,P<0.01)was an independent predictor of ARNI dose titration.Conclusion Most of the patients use ARNI at a maintenance level below the target dose level.Although the cardiac function has been improved significantly,the patients still miss the opportunity to increase the drug titration,and do not get the best benefit.At present,ARNI titration is often achieved through readmission,so it is necessary to strengthen the education and follow-up management of patients with heart failure.
作者
邵夏炎
杨贝贝
刘洪智
徐予
SHAO Xiayan;YANG Beibei;LIU Hongzhi;XU Yu(Department of Cardiology,The People′s Hospital of Henan University,Zhengzhou,Henan,450003;Department of Cardiology,Henan Provincial People′s Hospital,Zhengzhou,Henan,450003)
出处
《实用临床医药杂志》
CAS
2020年第2期22-25,28,共5页
Journal of Clinical Medicine in Practice
基金
河南省科技发展计划(192112310063)
河南省医学科技攻关计划项目(2018020441)
关键词
沙库巴曲缬沙坦
心力衰竭
滴定
随访管理
射血分数降低的心力衰竭
sacubitril/valsartan
heart failure
titration
follow-up management
heart failure with reduced ejection fraction
