老年慢性心衰规范化内科治疗临床疗效观察

Q: What are the key findings of this study?

规范化四联药物治疗结合智能预警与多学科分层随访，将老年慢性心衰患者的1年内再住院率从40.0%显著降低至20.0%。

Q: What is the clinical evidence from this study?

Study design: RCT. Population: 老年慢性心力衰竭 (n=240). Intervention: 四联药物标准治疗联合智能监测与多学科分层随访 vs. 常规药物（以单药或二联为主）及常规门诊随访. Primary outcome: 1年内再住院率 (p=0.009).

Q: What does this research mean for the field?

规范化四联药物治疗结合智能预警与多学科分层随访，将老年慢性心衰患者的1年内再住院率从40.0%显著降低至20.0%，并显著改善心功能与降低全因死亡率。 Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

刘红玉

doi:10.37155/2661-4766-0806-23

January 1, 2026临床医学前沿Open Access

老年慢性心衰规范化内科治疗临床疗效观察

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Key result

Smart monitoring and multidisciplinary follow-up with GDMT halves 1-year heart failure readmissions to ~20%.

P=0.009
n=240

Why the study?

The impact of standardized quadruple drug therapy combined with intelligent monitoring and stratified follow-up on elderly chronic heart failure patients' cardiac function, rehospitalization, and survival prognosis was unclear.

Does quadruple guideline-directed medical therapy combined with smart monitoring and multidisciplinary stratified follow-up improve cardiac function and reduce mortality and rehospitalization in elderly patients with HFrEF?

Key Points

To investigate the effects of standardized quadruple drug therapy combined with smart wearable monitoring and risk-stratified follow-up on cardiac function, readmission rates, and survival outcomes in elderly patients with chronic heart failure.
Study conducted in China enrolling 240 elderly patients aged 60–85 years with chronic heart failure and reduced ejection fraction (LVEF ≤ 40%), randomly assigned 1:1 to an observation group (n=120) or a control group (n=120).
The observation group received standardized quadruple medical therapy (ACEI/ARB, beta-blocker, MRA, and SGLT2 inhibitor) combined with wearable biometric monitoring, stratified follow-up based on NYHA class, and multidisciplinary management; the control group received conventional dual therapy and routine clinic follow-up.
Outcomes were assessed by echocardiography (LVEF), serum B-type natriuretic peptide (BNP), 6-minute walk distance, and 6-month and 1-year clinical endpoints (readmission and all-cause mortality).
At 1 year, the observation group achieved a significantly lower readmission rate (20.00% [24/120] vs. 40.00% [48/120], χ² = 6.789, P = 0.009) and a significantly lower all-cause mortality rate (10.00% [12/120] vs. 20.00% [24/120], χ² = 4.567, P = 0.032) compared with the control group.
Cardiac function improved significantly more in the observation group compared to controls: post-treatment LVEF increased to 45.60±5.20% vs. 40.10±4.90% (P < 0.001), BNP decreased to 300.20±100.50 pg/ml vs. 380.40±120.30 pg/ml (P < 0.001), and 6-minute walk distance reached 400.80±70.10 m vs. 360.50±65.40 m (P = 0.001).
Higher medication adherence showed a strong positive dose-response relationship with target clinical endpoints, with high adherence (≥ 90%) yielding higher rates of LVEF improvement ≥ 5% (90.0% vs. 40.0% in low adherence, P < 0.001) and BNP reduction ≥ 30% (87.5% vs. 35.0%, P < 0.001).

Study Design

Type

RCT (n=240)

Randomization

随机数字表法

Multicenter

No

Structured PICO

Does quadruple guideline-directed medical therapy combined with smart monitoring and multidisciplinary stratified follow-up improve cardiac function and reduce mortality and rehospitalization in elderly patients with HFrEF?

P

Population

纳入240例LVEF ≤ 40%的老年慢性心衰患者（平均年龄72.5岁），比较四联药物联合智能管理与常规治疗的临床结局，随访1年。

I

Intervention

Standardized quadruple guideline-directed medical therapy (ACEI/ARB, beta-blocker, MRA, and SGLT2 inhibitor) titrated to target/max tolerated dose, combined with smart wearable dynamic monitoring (ECG, weight), mobile APP alerts, stratified follow-up based on NYHA class, and multidisciplinary team management.

C

Comparator

Conventional medical therapy (mainly ACEI/ARB and beta-blocker monotherapy or dual therapy, without routine SGLT2i or MRA) with routine unstructured outpatient follow-up and no smart monitoring.

O

Outcome

Cardiac function (LVEF, BNP), 6-minute walk distance at 4 weeks, and clinical events (rehospitalization and all-cause mortality) at 6 and 12 months.hard clinical

Main Result

Absolute Event Rate: 20% vs 40%

p-value: p=0.009

Integrating guideline-directed quadruple medical therapy with smart wearable monitoring and a multidisciplinary team approach significantly improves cardiac remodeling, functional capacity, and clinical survival in elderly HFrEF patients.

Limitations

未在正文中明确报告研究局限性

Implication

May support integrated quadruple therapy with alerts in elderly HF; leaves open randomized confirmation before practice change.

Abstract

目的：探讨四联药物联合智能监测及分层随访对老年慢性心衰患者心功能、再住院率及生存预后的影响。方法：纳入240例老年慢性心衰患者，随机分为观察组与对照组。观察组予四联药物标准化治疗，整合智能穿戴动态监测、分层随访路径与多学科协同管理；对照组予常规药物及门诊随访。通过超声心动图、生物标志物、运动耐量及临床终点事件评估疗效。结果：观察组心功能改善、运动耐量提升及bnp下降均优于对照组，再住院率与全因死亡率降低，不同nyha分级中均见获益，中重度患者更明显；药物依从性越高，临床疗效达标率越高，呈正向剂量效应。结论：规范化药物治疗结合智能预警与多学科管理，可促进心功能重构与容量稳态，改善老年慢性心衰远期预后，具有可推广性，为基层心衰同质化管理提供依据。

Discussion

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Cite This Study

刘红玉 (2026) conducted an RCT in 老年慢性心力衰竭 (n=240). 四联药物标准治疗联合智能监测与多学科分层随访 vs. 常规药物（以单药或二联为主）及常规门诊随访 was evaluated on 1年内再住院率 (p=0.009). 规范化四联药物治疗结合智能预警与多学科分层随访，将老年慢性心衰患者的1年内再住院率从40.0%显著降低至20.0%。.

synapsesocial.com/papers/6ad34de0727baf805bb60eb4 https://doi.org/10.37155/2661-4766-0806-23

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老年慢性心衰规范化内科治疗临床疗效观察

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

老年慢性心衰规范化内科治疗临床疗效观察

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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