发布日期：2015-02-10
英文标题：The vulnerable phase after hospitalization for heart failure.
作者：Stephen J et al.
出处：Nature Reviews Cardiology 2015 12(4): 220–229
内容介绍：
心力衰竭 (以下简称「心衰」) 是由于心脏结构或功能异常导致心室充盈或射血能力受损的一组复杂临床综合征。作为多种心血管疾病的终末阶段，心衰因其发病率、死亡率高，已成为 21 世纪心血管医师最后的战场。尽管住院期间的治疗可有效缓解心衰症状，但心衰患者出院后临床转归仍不尽如人意。基于目前的治疗手段，心力衰竭患者出院后 60-90 天内的死亡率和再入院率分别为 15% 和 30%。这一出院后早期心血管不良事件高发的时期被称为心衰患者的「易损期」，此阶段属于不良预后高危阶段。
摘要展示：
Despite available therapy, mortality and readmission rates within 60–90 days of discharge for patients hospitalized with heart failure (HF) approach 15% and 30%, respectively. This early postdischarge period has been termed the 『vulnerable phase』 and accounts for a disproportionate amount of the >US$30 billion spent annually on HF care in the USA. The pathophysiology underlying these early adverse events is likely associated with persistently elevated filling pressures at time of discharge and subsequent acute or subacute worsening of postdischarge haemodynamics. Despite limited proven strategies to reduce early adverse events, hospitals in the USA face penalties for 30‑day readmission rates that exceed current expectations, and an urgent need exists for novel approaches to improve early postdischarge outcomes. The objective of this Review is to describe the early postdischarge problem among patients hospitalized for HF, the associated patient profile and pathophysiology, and the limitations of current postdischarge treatment strategies. We also identify therapeutic targets and outline a progressive management approach that should be considered by clinicians for reducing early postdischarge morbidity and mortality. Although these strategies require prospective validation, they are practical, affordable, and have the potential to improve patient outcomes substantially after HF hospitalization
