Circulation:合理治疗心衰后病情会得到很大改善
2012-02-24 MedSci MedSci原创
心力衰竭又称“心肌衰竭”,是指心脏当时不能搏出同静脉回流及身体组织代谢所需相称的血液供应。往往由各种疾病引起心肌收缩能力减弱,从而使心脏的血液输出量减少,不足以满足机体的需要,并由此产生一系列症状和体征。 据不完全统计,美国现今有600多万成年人存在心衰症状。但可以喜的是虽然心衰发病率逐年上升,但迄今为止没有相关证据表明随着心衰发病率的升高,其引发的死亡率也上升。 来自洛杉矶加利福尼亚大学的心
心力衰竭又称“心肌衰竭”,是指心脏当时不能搏出同静脉回流及身体组织代谢所需相称的血液供应。往往由各种疾病引起心肌收缩能力减弱,从而使心脏的血液输出量减少,不足以满足机体的需要,并由此产生一系列症状和体征。
据不完全统计,美国现今有600多万成年人存在心衰症状。但可以喜的是虽然心衰发病率逐年上升,但迄今为止没有相关证据表明随着心衰发病率的升高,其引发的死亡率也上升。
来自洛杉矶加利福尼亚大学的心脏病专家--Gregg C. Fonarow医学博士称:虽然就目前来说患心衰的人数在不断增加,但心衰患者接受治疗后结果很乐观,病人预后情况能得到逐步改善。有部分更好的治疗方法和程序的证据。在这个领域有大量的研究和进步,过去是令人沮丧的诊断结果不再是标准。使用适当的,有效的内科和设备治疗方法比从前的猜想更有效,现在表明更好的康复锻炼能拯救生命。
一旦我们患上心衰后,心脏功能衰退不能充分地给我们机体各大器官供应血液。最明显的表现就是我们很容易觉得疲劳或是呼吸短促,甚至稍微一活动就觉得体力不支。但即使我们一不小心患上心衰后,就目前来说通过医学措施也能使得很多心衰病人心脏功能得到恢复。
美国心脏协会前主席--Clyde Yancy医学博士表示:患上晚期心衰疾病一点也不可怕,现在医学上有不胜其数的治疗手段可供选择使用如人工心脏泵设备,这一设备在当前治疗心衰患者中越来越受到重用。人工心脏泵作为心衰最可靠的治疗方法,不同于以前的心肌功能康复治疗。给心衰患者一人工心脏泵设备,可以维持患者生命,让患者有足够长的时间等待心脏移植的机会。
该项究表明:在接下来的两年里,只要心衰患者根据美国心脏协会的指导建议下接受正规合理治疗的话,病人的预后会大大得到改善。
doi:10.1161/CIRCULATIONAHA.110.989632
Associations Between Outpatient Heart Failure Process-of-Care Measures and Mortality
Gregg C. Fonarow, MD; Nancy M. Albert, PhD, RN; Anne B. Curtis, MD; Mihai Gheorghiade, MD; J. Thomas Heywood, MD; Yang Liu, MS; Mandeep R. Mehra, MD; Christopher M. O'Connor, MD; Dwight Reynolds, MD; et al.
Background—Assessment of the quality of care for outpatients with heart failure (HF) has focused on the development and use of process-based performance measures, with the supposition that these care process measures are associated with clinical outcomes. However, this association has not been evaluated for current and emerging outpatient HF measures.
Methods and Results—Performance on 7 HF process measures (4 current and 3 emerging) and 2 summary measures was assessed at baseline in patients from 167 US outpatient cardiology practices with patients prospectively followed up for 24 months. Participants included 15 177 patients with reduced left ventricular ejection fraction (≤35%) and chronic HF or post–myocardial infarction. Multivariable analyses were performed to assess the process-outcome relationship for each measure in eligible patients. Vital status was available for 11 621 patients. The mortality rate at 24 months was 22.1%. Angiotensin-converting enzyme inhibitor or angiotensin receptor blocker use, β-blocker use, anticoagulant therapy for atrial fibrillation, cardiac resynchronization therapy, implantable cardioverter-defibrillators, and HF education for eligible patients were each independently associated with improved 24-month survival, whereas aldosterone antagonist use was not. The all-or-none and composite care summary measures were also independently associated with improved survival. Each 10% improvement in composite care was associated with a 13% lower odds of 24-month mortality (adjusted odds ratio, 0.87; 95% confidence interval, 0.84 to 0.90; P<0.0001).
Conclusions—Current and emerging outpatient HF process measures are positively associated with patient survival. These HF measures may be useful for assessing and improving HF care.
作者:MedSci
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