■为了确定指南指导的药物治疗(GDMT)非处方背后的原因,在排除GDMT无法忍受的药物之前和之后,以及阿曼射血分数降低(<40%)(HFrEF)的心力衰竭(HF)患者的剂量优化。
■该研究包括在苏丹卡布斯大学医院门诊就诊的HF患者,马斯喀特,阿曼,2016年1月至2019年12月,并跟进至2021年6月底。使用肾素-血管紧张素系统(RAS)阻滞剂(血管紧张素转换酶抑制剂(ACEI)或血管紧张素II受体阻滞剂(ARB)或血管紧张素受体-脑啡肽抑制剂(ARNI)),β受体阻滞剂和盐皮质激素受体拮抗剂(MRA)按照欧洲,美国人,和加拿大HF指南。使用单变量统计学进行分析。
■本研究共纳入171名HFrEF患者,队列的总体平均年龄为63±15岁,59%为男性.超过65%的患者患有慢性肾病。几乎55%的患者对GDMT无法忍受。使用β受体阻滞剂的患者比例,RAS阻滞剂/肼屈嗪-硝酸异山梨酯组合,和MRA,在排除GDMT无法忍受的之前和之后,是89%,97%,77%,and,94%,47%和85%,分别,同时使用GDMT组合的患者比例为41%和83%,分别。总共61%,44%和100%的患者处方≥50%的目标剂量为β受体阻滞剂,RAS阻断剂/HYD-ISDN组合和MRA,而19%,8.2%和94%的患者达到了β受体阻滞剂目标剂量的100%,RAS阻断剂/HYD-ISDN组合和MRA。
■GDMT非处方的原因在患者的医疗记录中是频繁且不明显的。大多数患者服用GDMT。然而,剂量优化,特别适用于β受体阻滞剂和RAS受体阻滞剂/HYD-ISDN组合,仍然是次优的。研究结果应在低研究能力的背景下解释,未来的研究,样本量较大,有必要尽量减少这种限制。
UNASSIGNED: To determine the reasons behind
guideline-directed medical therapy (GDMT) non-prescribing, drug utilization before and after excluding those intolerable to GDMT, as well as dose optimization in heart failure (HF) patients with reduced ejection fraction (<40%) (HFrEF) in
Oman.
UNASSIGNED: The study included HF patients seen at the medical outpatient clinics at Sultan Qaboos University Hospital, Muscat,
Oman, between January 2016 and December 2019 and followed up until the end of June 2021. The use of renin-angiotensin-system (RAS) blockers (angiotensin-converting-enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) or angiotensin receptor-neprilysin inhibitors (ARNIs)), beta blockers and mineralocorticoid receptor antagonists (MRAs) were evaluated as per the European, American, and Canadian HF
guidelines. Analyses were performed using univariate statistics.
UNASSIGNED: A total of 171 HFrEF patients were enrolled for this study, the overall mean age of the cohort was 63 ± 15 years old and 59% were male. Over 65% of the patients had chronic kidney disease. Almost 55% of the patients were intolerable to GDMT. The proportion of patients on beta blockers, RAS blockers/ hydralazine-isosorbide dinitrate combination, and MRAs, before and after excluding those intolerable to GDMT, were 89%, 97%, and 77%, and, 94%, 47% and 85%, respectively, while the proportion of patients on the GDMT combination concomitantly was 41% and 83%, respectively. A total of 61%, 44% and 100% of the patients were prescribed ≥50% of the target dose for beta blockers, RAS blockers/ HYD-ISDN combination and MRAs respectively, while 19%, 8.2% and 94% of the patients attained 100% of the target dose for beta blockers, RAS blockers/ HYD-ISDN combination and MRAs respectively.
UNASSIGNED: Reasons behind GDMT non-prescribing were frequent and not clearly obvious in patients\' medical notes. The majority of the patients were prescribed GDMT. However, dose optimization, specifically for beta blockers and RAS blockers/ HYD-ISDN combination, was still suboptimal. The findings should be interpreted in the context of low study power and that future studies, with larger sample sizes, are warranted to minimize this limitation.