Current Status of Drug Treatment for Chronic Heart Failure Patients With Reduced Ejection Fraction in Yunnan： a Single-center Survey

Danhong DONG; Weiwen WANG; Dexia LI; Jun YANG; Na LI; Hang MA; Lin LI

doi:10.12259/j.issn.2095-610X.S20230822

Volume 44 Issue 8

Aug. 2023

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Danhong DONG, Weiwen WANG, Dexia LI, Jun YANG, Na LI, Hang MA, Lin LI. Current Status of Drug Treatment for Chronic Heart Failure Patients With Reduced Ejection Fraction in Yunnan： a Single-center Survey[J]. Journal of Kunming Medical University, 2023, 44(8): 77-84. doi: 10.12259/j.issn.2095-610X.S20230822

Citation:

Danhong DONG, Weiwen WANG, Dexia LI, Jun YANG, Na LI, Hang MA, Lin LI. Current Status of Drug Treatment for Chronic Heart Failure Patients With Reduced Ejection Fraction in Yunnan： a Single-center Survey[J]. Journal of Kunming Medical University, 2023, 44(8): 77-84. doi: 10.12259/j.issn.2095-610X.S20230822

Citation:

Danhong DONG, Weiwen WANG, Dexia LI, Jun YANG, Na LI, Hang MA, Lin LI. Current Status of Drug Treatment for Chronic Heart Failure Patients With Reduced Ejection Fraction in Yunnan： a Single-center Survey[J]. Journal of Kunming Medical University, 2023, 44(8): 77-84. doi: 10.12259/j.issn.2095-610X.S20230822

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Current Status of Drug Treatment for Chronic Heart Failure Patients With Reduced Ejection Fraction in Yunnan： a Single-center Survey

doi: 10.12259/j.issn.2095-610X.S20230822

Danhong DONG¹,
Weiwen WANG²,
Dexia LI³,
Jun YANG¹,
Na LI¹,
Hang MA¹,
Lin LI^{1
,
,}

1.
Dept. of Cardiology，The First Affiliated Hospital of Kunming Medical University，Kunming Yunnan 650032
2.
Dept. of Cardiology，Yunnan Fuwai Cardiovascular Hospital，Kunming Yunnan 650102
3.
Dept. of General Practice，Lijiang People’s Hospital， Lijiang Yunnan 674100，China

Received Date: 2023-06-18
Available Online: 2023-09-06
Publish Date: 2023-08-30

Abstract

Abstract

Objective To investigate the status quo of drug therapy and the factors affecting the standardized drug therapy in patients with heart failure with chronic ejection fraction reduction （HFrEF） in Yunnan province. Methods This is a single-center, prospective, and observational study. A total of 110 patients who were hospitalized in the Department of Cardiology in the First Affiliated Hospital of Kunming Medical University during July 2019 to September 2020 were enrolled.The utilization rate and dose of ACEI/ARB/ARNI, β-blocker and MRA were collected during hospitalization, 3 and 6 months after discharge. According to the drug dose at discharge, patients were divided into 100% target dose group, 50% ～ 99% target dose group and < 50% target dose group, and the factors affecting the standardized drug treatment were analyzed. Results The average age of 110 HFrEF patients was （57.9±14.1） years old, among which 65 （58.6%） were males. The utilization rates of ACEI/ARB/ARNI, β-blocker and MRA at discharge （73.6% , 82.1% , 89.6% , respectively） were higher than that at 3 months （69.8% , 79.2% , 84.4% , respectively） and 6 months （69.0% , 78.6% , 78.6% , respectively） after discharge. Both of 100% target dose of ACEI/ARB/ARNI and β-blocker were lower at the time of discharge, 3 and 6 months after discharge, among which the 100% target dose rate of β-blocker was the lowest. ACEI/ARB/ARNI and β-blocker usage at 100% target dose was lower at discharge, 3 months after discharge, and 6 months after discharge, with rates of 12.8% and 1.1%, 14.9% and 0%, and 15.5% and 1.5% respectively. Among them, the rate of reaching the target dose was the lowest for β-blockers. When comparing the three groups of 100% target dose, 50-99% target dose, and < 50% target dose, patients in the ACEI/ARB/ARNI 50-99% target dose group had higher body mass index （25.5±3.4 vs. 23.2±4.1, P = 0.038） and systolic blood pressure （131.1±21.6 vs 109.7±14.9, P < 0.001） than those in the < 50% target dose group. There were no significant differences in NYHA functional classification, BNP, and serum creatinine among the three groups （P > 0.05）. The age of patients in the β-blocker 50-99% target dose group was significantly lower than that in the < 50% target dose group （46.9±10.0 vs. 64.4±13.2, P = 0.005）, and there were no significant differences in NYHA functional classification, heart rate, and systolic blood pressure among the three groups （P > 0.05）. During hospitalization, the main reasons for the underuse or suboptimal dose of heart failure medications were lack of prescription by doctors, drug intolerance, and contraindications. After discharge, apart from contraindications, the main reasons for non-compliance with medication guidelines were patient self-discontinuation and lack of prescription by doctors. Conclusions In HFrEF patients in some areas of Yunnan Province, the utilization rate and dosage of ACEI/ARB/ARNI and β-blockers were low. With the extension of discharge time, the utilization rate of drugs continued to decline, and the dosage did not increase significantly. Drug contraindications or intolerances in patients, self-withdrawal after discharge and non-prescription by doctors are the important reasons for non-standardized drug use.
- Heart failure with reduced ejection fraction,
- Drug treatment,
- Influencing factor

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References(15)

References

[1]	中华医学会心血管病学分会;中华心血管病杂志编辑委员会. 中国心力衰竭诊断和治疗指南2014[J]. 中华心血管病杂志,2014,42(2):98-122.
[2]	中华医学会心血管病学分会心力衰竭学组;中国医师协会心力衰竭专业委员会;中华心血管病杂志编辑委员会. 中国心力衰竭诊断和治疗指南2018[J]. 中华心血管病杂志,2018,46(10):760-789.
[3]	中国心血管健康与疾病报告编写组. 中国心血管健康与疾病报告2019[J]. 中国循环杂志,2020,35:833-854.
[4]	国家卫生计生委合理用药专家委员会;中国药师协会. 心力衰竭合理用药指南(第2版)[J]. 中国医学前沿杂志,2019,11(7):1-78.
[5]	Rossignol P,Hernandez A F,Solomon S D,et al. Heart failure drug treatment[J]. The Lancet,2019,393(10175):1034-1044. doi: 10.1016/S0140-6736(18)31808-7
[6]	Braunwald E. The path to an angiotensin receptor antagonist-neprilysin inhibitor in the treatment of heart failure[J]. J Am Coll Cardiol,2015,65(10):1029-1041. doi: 10.1016/j.jacc.2015.01.033
[7]	Dickstein K,Cohen-Solal A,Filippatos G,et al. Guidelines ESCCfP. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the task force for the diagnosis and treatment of acute and chronic heart failure 2008 of the european society of cardiology. developed in collaboration with the heart failure association of the ESC (HFA) and endorsed by the European Society of Intensive care medicine[J]. Eur Heart J,2008,29(19):2388-2442. doi: 10.1093/eurheartj/ehn309
[8]	Yancy C W,Jessup M,Bozkurt B,et al. 2017 ACC/AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure: a report of the american college of cardiology/american heart association task force on clinical practice guidelines and the heart failure society of America[J]. Circulation,2017,136(6):e137-e161.
[9]	张健,张宇辉. 多中心、前瞻性中国心力衰竭注册登记研究—病因、临床特点和治疗情况初步分析[J]. 中国循环杂志,2015,30(5):413-416.
[10]	袁华苑, 韩明华. 2106例慢性心力衰竭患者规范化管理及治疗现状调查分析 [D]. 昆明: 昆明医科大学, 2014.
[11]	王华,李莹莹,柴坷,等. 中国住院心力衰竭患者流行病学及治疗现状[J]. 中华心血管病杂志,2019,47(11):865-874.
[12]	Greene S J,Butler J,Albert N M,et al. Medical therapy for heart failure with reduced ejection fraction: the CHAMP-HF registry[J]. J Am Coll Cardiol,2018,72(4):351-366. doi: 10.1016/j.jacc.2018.04.070
[13]	Uijl A,Vaartjes I,Denaxas S,et al. Temporal trends in heart failure medication prescription in a population-based cohort study[J]. BMJ Open,2021,11(3):e043290. doi: 10.1136/bmjopen-2020-043290
[14]	李长平,王燕萍,陈忠. 慢性心力衰竭患者院外管理研究进展[J]. 现代医学,2019,47(10):1288-1291.
[15]	Larsson S C,Orsini N,Wolk A. Alcohol consumption and risk of heart failure: a dose-response meta-analysis of prospective studies[J]. Eur J Heart Fail,2015,17(4):367-373. doi: 10.1002/ejhf.228

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