| BackgroundHeart failure(HF),referred to as heart failure,is a serious manifestation or terminal stage of various heart diseases,which significantly reduces the quality of life of patients,and its morbidity,readmission rate and fatality rate remain high.Drug therapy for patients with previous chronic Heart failure with reduced ejection fraction(HFr EF)is the renin-angiotensin system,(RAS)inhibitors [including angiotensin converting enzyme inhibitors(ACEI),angiotensin receptor antagonists(ARB),angiotensin receptor enkephalase inhibitors(ARNI)],beta blockers(BB),mineralocorticoid receptor antagonists(MRA),The combination of three types of drugs forms the basis of the "Golden Triangle" regimen(ARNI/ACEI/ARB+BB+MRA).In 2021,the European Society of Cardiology(ESC)proposed that sodium-glucose cotransporter 2 inhibitors(SGLT2i)can reduce the readmission rate and mortality in patients with HFr EF.Therefore,the "new quadruple therapy" regimen(ARNI/ACEI/ARB+BB+MRA+SGLT2i)formed by adding SGLT2 i drugs on the basis of the "Golden Triangle" regimen can further reduce the readmission rate and mortality of patients with chronic HFr EF,and improve the prognosis of patients.However,there are few researches on the standardized treatment of "new tetrad"(ARNI/ACEI/ARB,BB,MRA,SGLT2i).At the same time,the standardized treatment of chronic heart failure patients is not ideal in the actual clinical work,especially the combination of drugs and the titration of doses are far from the guideline recommendations,so it is necessary to study the standardized treatment of "new quadruple therapy" drugs for HFr EF patients.In addition,there were few studies comparing basic clinical features and pharmacotherapy in patients with heart failure with mid-range ejection fraction(HFmr EF)in patients with heart failure with reduced ejection fraction.Therefore,it is necessary to compare the differences in basic clinical features and medical therapy between patients with reduced ejection fraction and median heart failure.Objective1.To investigate the current situation of the use of "new quadruple therapy" drugs in patients with heart failure with reduced ejection fraction,and analyze the factors affecting the standardized treatment of drugs.2.To compare the clinical characteristics and drug use of patients with decreased ejection fraction and intermediate heart failure.MethodsThe case data of heart failure patients admitted to the Department of Cardiology and the Department of General Practice of the Second Affiliated Hospital of Shenyang Medical College from October 2021 to September 2022 were prospectively collected,including the general clinical data of heart failure patients,the use of "new quadruple therapy" drugs,laboratory examination and cardiac ultrasound examination results,etc.According to the left ventricular ejection fraction(LVEF),patients were divided into HFr EF group(LVEF < 40%)and HFmr EF group(40≤%LVEF < 50%),and the clinical characteristics and drug use of the two groups were compared.According to the combined use of four types of drugs(ARNI/ACEI/ARB,BB,MRA,SGLT2i),patients with heart failure in the reduced ejection fraction(HFr EF)group were divided into "two or less groups","three groups" and "four groups".Clinical characteristics of different groups were compared,and factors affecting drug use were analyzed.The collected heart failure patients with reduced ejection fraction were followed up by telephone three months after discharge to investigate the use of "new quadruple" drugs,to understand the readmissions and death of patients due to cardiovascular disease,and to establish a database to analyze the factors affecting drug use.Results1.A total of 182 patients with chronic heart failure were included in this study,including 110 males(60.4%)and 72 females(39.5%),with an average age of70.9±11.3 years old,52 smokers(28.5%),34 drinkers(18.7%),and 118 HFr EF patients(64.8%).64 patients(35.2%)were HFmr EF patients.Comorbidities in patients with heart failure: The comorbiditions of HFr EF patients were coronary heart disease(80.5%)(95/118),hypertension(51.7%)(61/118),myocardial infarction(43.2%)(51/118),atrial fibrillation(26.3%)(31/118),diabetes mellitus(25.4%).Chronic renal insufficiency accounted for 19.5%(23/118).The comorbiditions of HFmr EF were 89.1%(57/64)of coronary heart disease,71.9%(46/64)of hypertension,34.4%(22/64)of diabetes,32.8%(21/64)of myocardial infarction and 29.7%(19/64)of atrial fibrillation.Chronic renal insufficiency accounted for 26.6%(17/64).2.Percentage of "new quadruple therapy" drug use in patients with chronic HFr EF at discharge: MRA(spironolide)89.0%(105/118),BB drugs 83.9%(99/118),RAS inhibitors 82.2%(97/118),SGLT2 i drugs 22.9%(27/118),"new quadruple therapy" regimen 16.9%(20/118),Three types of drugs were used in combination 50%(59/118)and two types of drugs in combination 27.1%(32/118).3.Percentage of "new quadruple therapy" drug use in patients with chronic HFr EF three months after discharge: MRA(spironolactone)drugs 84.6%,BB drugs80.8%,RAS inhibitors 77.9%,SGLT2 i drugs 22.1%,"new quadruple therapy" scheme16.3%,combined use of three types of drugs 50.0%,combined use of two types of drugs 20.2%.The rate of use of SGLT2 i and the "new quadruple" regimen remained low compared with discharge.4.In patients with chronic HFrEF,the percentage of RAS inhibitor dose applied at discharge was 65.6%(63/96)< 50% target dose,31.3%(30/96)< 100% target dose,3.1%(3/96)100% target dose;Percentage of BB dose applied: < 50% target dose73.7%(73/99),50% to < 100% target dose 21.2%(21/99),100% target dose 5.1%(5/99).5.Three months after discharge of patients with chronic HFr EF,the percentages of RAS inhibitor dosages applied were: < 50% target dose 55.0%(44/80),50% to <100% target dose 41.2%(33/80),100% target dose 3.8%(3/80);Percentage of BB dose applied: < 50% target dose 65.5%(55/84),50% to < 100% target dose 28.6%(24/84),100% target dose 5.9%(5/84).Compared with the time of discharge,the dosage of RAS inhibitors and BB drugs did not change much,and the dosage was still low.6.Three months after discharge,115 HFrEF patients were followed up,of which 11 died(9.6%)and 28 were readmitted after discharge(24.3%).Six patients(5.2%)had no contraindications or intolerance to self-discontinuation;41.3%(43/104)of the patients went to the hospital for follow-up visit,and 21.1%(22/104)of them titrated RAS inhibitors,BB drugs or added other types of drugs after follow-up visit.7.Percentage of drugs used by patients with HFmr EF at discharge: 81.3% BB drugs,78.1% RAS inhibitors,76.6% MRA(spironolactone)drugs,10.9% SGLT2 i drugs,6.3% "new quadruple therapy" regimen.8.Patients with HFr EF and HFmr EF have different clinical characteristics and drug use.Between HFr EF group and HFmr EF group,NT-pro BNP,cardiac function grading,hypertension,MRA,SGLT2 i and "new quadruple therapy" regimen were statistically significant(P < 0.05).9.Systolic blood pressure,diastolic blood pressure,heart rate,age,diabetes and fasting blood glucose were statistically significant among the four groups,three groups and two or less groups(P < 0.05).Conclusion1.Among the patients with chronic HFrEF hospitalized in the Second Affiliated Hospital of Shenyang Medical College,the taking rate of SGLT2 i drugs was low,and the combined use rate of "new quadruple" four types of drugs was low;Three months after discharge,the patient had poor titration of RAS blockers and BB drugs,and insufficient dose of drugs.The standardized treatment of "new quadruple" drugs in patients with chronic HFr EF in our hospital is poor.2.The low rate of SGLT2 i drug use in patients with chronic HFr EF is related with physician updates or inadequate implementation of new guidelines.Low dose of RAS inhibitors and BB drugs was associated with no return visit and no increase of drug dose by physicians after return visit.The blood pressure and heart rate of patients in the "double and below group" limited the use of the drug in combination.3.The use rate of RAS inhibitors and BB drugs in HFmr EF patients was higher,and there was little difference between the use rate of RAS inhibitors and BB drugs in HFr EF patients.The higher rate of taking RAS inhibitors and BB drugs in HFmr EF patients is related to the use of RAS inhibitors and BB drugs by physicians to treat the primary disease. |
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