Why the study?
Despite the absence of clinical contraindications in many patients with HFrEF, guideline-directed medical therapy remains underprescribed, requiring strategies to overcome barriers and implement the four foundational drug classes.
Early and rapid initiation of the four pillars of GDMT (ARNI, beta-blockers, MRAs, SGLT2i) is crucial for reducing morbidity and mortality in patients with HFrEF.
Early GDMT initiation in HFrEF may reduce morbidity and mortality; reinforces updated guideline emphasis on rapid titration.
Vzhledem k vysokĂŠmu riziku neŞådoucĂch ĂşÄinkĹŻ u pacientĹŻ se srdeÄnĂm selhĂĄnĂm a snĂĹženou ejekÄnĂ frakcĂ (heart failure and reduced ejection fraction, HFrEF) existuje nalĂŠhavĂĄ potĹeba zahĂĄjenĂ a titrace farmakoterapie podle doporuÄenĂ˝ch postupĹŻ (guideline-directed medical therapy, GDMT), kterĂĄ mĹŻĹže snĂĹžit morbiditu a riziko ĂşmrtĂ. DoporuÄenĂŠ postupy pro klinickou praxi nynĂ zdĹŻrazĹujĂ nutnost vÄasnĂŠho a rychlĂŠho zahĂĄjenĂ lĂŠÄby lĂĄtkami s kardiovaskulĂĄrnĂm pĹĂnosem. PĹi vÄdomĂ ÄetnĂ˝ch pĹekĂĄĹžek ztÄĹžujĂcĂch zahĂĄjenĂ a optimalizaci GDMT musĂ bĂ˝t cĂlem poskytovatelĹŻ zdravotnĂ pĂŠÄe uvĂĄdÄt do praxe ÄtyĹi pilĂĹe farmakoterapie kombinacĂ ÄtyĹ lĂŠkovĂ˝ch skupin, kterou dnes preferuje vÄtĹĄina doporuÄenĂ˝ch postupĹŻ pro klinickou praxi: inhibitory receptoru pro angiotenzin II a neprilysinu, beta-blokĂĄtory, antagonisty mineralokortikoidnĂch receptorĹŻ a inhibitory sodĂko-glukĂłzovĂŠho kotransportĂŠru 2. I kdyĹž u vysokĂŠho procenta pacientĹŻ s HFrEF nejsou pĹĂtomny ŞådnĂŠ klinickĂŠ kontraindikace GDMT, pĹesto jim tato lĂŠÄiva nejsou pĹedepisovĂĄna. VÄasnĂŠ zahĂĄjenĂ kombinaÄnĂ lĂŠÄby s nĂzkĂ˝mi dĂĄvkami by mÄla snĂĄĹĄet vÄtĹĄina pacientĹŻ. PĹi hledĂĄnĂ maximĂĄlnĂ tolerovanĂŠ GDMT bude nicmĂŠnÄ nutno zvaĹžovat i faktory na stranÄ pacientĹŻ, jako jsou jejich hemodynamickĂŠ pomÄry, kĹehkost a laboratornĂ hodnoty. DalĹĄĂ vĂ˝znamnou moĹžnost pro ĂşspÄĹĄnĂŠ provĂĄdÄnĂ GDMT pĹedstavuje zahĂĄjenĂ GDMT bÄhem hospitalizace pro akutnĂ srdeÄnĂ selhĂĄnĂ. Pro omezenĂ polypragmazie a snĂĹženĂ rizika neŞådoucĂch ĂşÄinkĹŻ lze koneÄnÄ zvaĹžovat i vysazenĂ lĂŠÄiv bez zjevnĂŠho pĹĂnosu pro kardiovaskulĂĄrnĂ systĂŠm. SnĂĹženĂ morbidity a mortality pacientĹŻ s HFrEF si vyŞådĂĄ dalĹĄĂ prospektivnĂ studie zamÄĹenĂŠ na optimĂĄlnĂ provĂĄdÄnĂ farmakoterapie ÄtyĹkombinacĂ. (J Am Coll Cardiol Basic Trans Science 2022;7:504-517) © 2021 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. Jde o ÄlĂĄnek vydanĂ˝ pod licencĂ CC BY-NC-ND (http://creativecommons.org/licenses/by-nc-nd/4.0/). ISSN 2452-302X, https://doi.org/10.1016/j.jacbts.2021.10.018
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Málek et al. (2022) studied this question.
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