Navigating between Scylla and Charybdis: challenges and strategies for implementing guideline-directed medical therapy in heart failure with reduced ejection fraction

被引：34

作者：

Seferovic, Petar M. ^{[1
,2
]}

Polovina, Marija ^{[1
,3
]}

Adlbrecht, Christopher ^{[4
]}

Belohlavek, Jan ^{[5
,6
]}

Chioncel, Ovidiu ^{[7
,8
]}

Goncalvesova, Eva ^{[9
,10
]}

Milinkovic, Ivan ^{[1
,3
]}

Grupper, Avishay ^{[11
,12
]}

Halmosi, Robert ^{[13
]}

Kamzola, Ginta ^{[14
]}

Koskinas, Konstantinos C. ^{[15
]}

Lopatin, Yuri ^{[16
]}

Parkhomenko, Alexander ^{[17
]}

Poder, Pentti ^{[18
]}

Ristic, Arsen D. ^{[1
,3
]}

Sakalyte, Gintare ^{[19
]}

Trbusic, Matias ^{[20
]}

Tundybayeva, Meiramgul ^{[21
]}

Vrtovec, Bojan ^{[22
]}

Yotov, Yoto T. ^{[23
,24
]}

Milicic, Davor ^{[20
]}

Ponikowski, Piotr ^{[25
]}

Metra, Marco ^{[26
]}

Rosano, Giuseppe ^{[27
]}

Coats, Andrew J. S. ^{[28
]}

机构：

[1] Univ Belgrade, Fac Med, Koste Todorovica 8, Belgrade 11000, Serbia

[2] Serbian Acad Arts & Sci, Belgrade, Serbia

[3] Univ Clin Ctr, Dept Cardiol, Belgrade, Serbia

[4] Imed19, Private Clin Res Ctr, Vienna, Austria

[5] Charles Univ Prague, Fac Med 1, Dept Cardiovasc Med, Dept Med 2, Prague, Czech Republic

[6] Gen Univ Hosp Prague, Prague, Czech Republic

[7] Univ Med & Pharm Carol Davila, Bucharest, Romania

[8] Emergency Inst Cardiovasc Dis Prof C C llliescu, Bucharest, Romania

[9] Comenius Univ, Natl Cardiovasc Inst, Dept Cardiol, Fac Med, Bratislava, Slovakia

[10] Natl Cardiovasc Inst, Bratislava, Slovakia

[11] Aviv Univ, Sheba Med Ctr, Cardiol Div, Tel Aviv, Israel

[12] Aviv Univ, Sackler Fac Med, Tel Aviv, Israel

[13] Univ Pecs, Med Sch, Dept Med 1, Pecs, Hungary

[14] Pauls Stradins Clin Univ Hosp, Latvian Ctr Cardiol, Riga, Latvia

[15] Bern Univ Hosp, Dept Cardiol, Bern, Switzerland

[16] Volgograd State Med Univ, Reg Cardiol Ctr Volgograd, Volgograd, Russia

[17] Inst Cardiol, Emergency Cardiol Dept, Kiev, Ukraine

[18] North Estonia Med Ctr Fdn, Cardiol Dept 1, Tallinn, Estonia

[19] Lithuanian Univ Hlth Sci, Med Acad, Dept Cardiol, Fac Med, Kaunas, Lithuania

[20] Univ Zagreb, Sch Med, Zagreb, Croatia

[21] Kazakh Natl Med Univ, Dept Cardiol, Alma Ata, Kazakhstan

[22] UMC, Dept Cardiol, Ljubljana, Slovenia

[23] Med Univ Varna, Dept Internal Med 1, Varna, Bulgaria

[24] Univ Hosp St, Cardiol Clin 2, Varna, Bulgaria

[25] Wroclaw Med Univ, Fac Hlth Sci, Ctr Heart Dis, Wroclaw, Poland

[26] Univ Brescia, Dept Med & Surg Specialties Radiol Sci & Publ Hlt, ASST Spedali Civili, Cardiol, Brescia, Italy

[27] RCCS San Raffaele Pisana, Rome, Italy

[28] Univ Warwick, Coventry, England

来源：

EUROPEAN JOURNAL OF HEART FAILURE | 2021年 / 23卷 / 12期

关键词：

Heart failure; Guideline-directed medical therapy; Optimal treatment; Medication adherence; Quality of care; Health education; Sodium-glucose co-transporter 2 inhibitors; DAPA-HF; RISK; EMPAGLIFLOZIN; INHIBITORS; OUTCOMES; LONG; GAPS;

D O I：

10.1002/ejhf.2378

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Guideline-directed medical therapy (GDMT) has the potential to reduce the risks of mortality and hospitalisation in patients with heart failure (HF) with reduced ejection fraction (HFrEF). However, real-world data indicate that many patients with HFrEF do not receive optimised GDMT, which involves several different medications, many of which require up-titration to target doses. There are many challenges to implementing GDMT, the most important being patient-related factors (comorbidities, advanced age, frailty, cognitive impairment, poor adherence, low socioeconomic status), treatment-related factors (intolerance, side-effects) and healthcare-related factors that influence availability and accessibility of HF care. Accordingly, international disparities in resources for HF management and limited public reimbursement of GDMT, coupled with clinical inertia for treatment intensification combine to hinder efforts to provide GDMT. In this review paper, authors aim to provide solutions based on available evidence, practical experience, and expert consensus on how to utilise evolving strategies, novel medications, and patient profiling to allow the more comprehensive uptake of GDMT. Authors discuss professional education, motivation, and training, as well as patient empowerment for self-care as important tools to overcome clinical inertia and boost GDMT implementation. We provide evidence on how multidisciplinary care and institutional accreditation can be successfully used to increase prescription rates and adherence to GDMT. We consider the role of modern technologies in advancing professional and patient education and facilitating patient-provider communication. Finally, authors emphasise the role of novel drugs (especially sodium-glucose co-transporter 2 inhibitors), and a tailored approach to drug management as evolving strategies for the more successful implementation of GDMT.

引用

页码：1999 / 2007

页数：9

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