“Heart failure decompensation events need to be paid great attention to. It should be known that among people aged ≥ 25 years in my country, 1/6 of the patients developed heart failure aggravation within 18 months after the initial diagnosis, and more than 1/2 had heart failure. Patients were hospitalized again within 30 days after the exacerbation event. Heart failure aggravation is closely related to the death and readmission of patients with chronic heart failure. The decompensated events of repeated hospitalization due to aggravation are increasing day by day, which has brought huge consequences to the society and the patient’s family. The public health and economic burden of the disease,” said Professor Yang Jiefu, director of the Department of Cardiology and Heart Center of Beijing Hospital.
Professor Yang Jiefu, Director of Cardiology Department and Heart Center of Beijing Hospital
On June 11, experts were jointly organized by the Chinese Geriatrics Association ECG and Cardiac Function Branch, the Chinese Medical Doctor Association Cardiovascular Branch, and the China Heart Failure Center Alliance Expert Committee, based on the latest clinical research results at home and abroad, referring to relevant guidelines, and combining The “Chinese Expert Consensus 2022 on the Comprehensive Management of Patients with Aggravated Chronic Heart Failure” (hereinafter referred to as the “Consensus”) written by my country’s national conditions and clinical practice was officially released online. The “Consensus” introduces the definition, diagnosis and evaluation, treatment, prevention and management of chronic heart failure exacerbation. Get timely, effective and standardized treatment, reduce heart failure re-hospitalization, improve the prognosis of heart failure patients, improve the overall prevention and treatment level of heart failure in my country, and then reduce the overall burden of the disease.
Irregular use of drugs has become the cause of spiral aggravation of heart failure
Exacerbation of chronic heart failure refers to the aggravation of symptoms and/or signs in patients with chronic heart failure after a period of stable disease. Clinically, it is often manifested as gradual decompensation of heart failure (increased volume load), and acute lung failure may occur in severe patients. Edema or cardiogenic shock.
There are many reasons for the exacerbation of heart failure, including advanced age, long course of heart failure, infection, arrhythmia, hypervolemia, excessive physical exertion, exacerbation of existing heart disease or other diseases, self-discontinuation or dose change, and no regular follow-up. and many more. Among them, the non-standard drug treatment is one of the important incentives.
In recent years, new drugs for the treatment of heart failure have emerged, including angiotensin receptor-enkephalinase inhibitor (ARNI), sodium-glucose cotransporter 2 inhibitor (SGLT-2i), and on May 18 this year. The soluble guanylate cyclase (sGC) stimulator, which was just approved in Japan, has brought the treatment of chronic heart failure into a new era of multi-mechanism and multi-channel combined therapy. Professor Wang Hua, Department of Cardiology, Beijing Hospital, said: “Heart failure includes multiple pathophysiological mechanisms, and various studies have shown that the more anti-heart failure drugs combined with different mechanisms of action, can prevent further aggravation of heart failure and maximize patient prognosis. .”
However, in the current domestic clinical practice, many doctors have insufficient understanding of the treatment concept of prognosis, and the drug treatment of heart failure generally has the current situation of insufficient use of drugs to improve the prognosis, and the gap with the latest evidence-based evidence, which affects the prognosis of patients. quality, and increase the probability of exacerbation of heart failure in patients.
Promote risk stratification and encourage combination therapy
The “Consensus” proposes risk stratification for patients with exacerbation of chronic heart failure. According to the speed, severity, hemodynamics, biomarkers, liver and kidney and other organ function status, comorbidities, complications, age and other comprehensive factors of heart failure exacerbation, patients can be divided into low-risk, intermediate-risk and high-risk. And developed corresponding management approaches and treatment strategies.
The “Consensus” states that low-risk patients can receive diuretics, renin-angiotensin system (RAS) inhibitors, beta-blockers, aldosterone receptor antagonists (MRAs), sodium-glucose cotransporters in outpatient clinics 2 (SGLT-2) inhibitors and combination therapy with drugs such as Vericiguat. Intermediate-risk patients require hospitalization or emergency treatment, and high-risk patients should be immediately admitted or transferred to an intensive care unit.
It is worth noting that, as a treatment recommendation for patients with exacerbation of chronic heart failure, veliciguat has been written into the “Consensus” for the first time. Prof. Hua Wang said: “Velixiguat is an oral sGC stimulator that can directly stimulate sGC independent of the concentration of nitric oxide (NO), and at the same time can increase the sensitivity of NO through dual mechanisms. sGC produces cGMP, which inhibits ventricular remodeling and has anti-myocardial fibrosis effects. Its representative clinical study, the VICTORIA study, evaluated velociraptor in patients with chronic HFrEF (heart failure with reduced ejection fraction) who had recently experienced a worsening event of heart failure. The risk of cardiovascular death or first hospitalization for heart failure was significantly reduced by 10% in the Guava treatment group compared to the placebo group, and the absolute risk of events was reduced by 4.2%, NNT24. Clearly, the new mechanism of action brings new hope to patients with heart failure.”
At the same time, the “Consensus” also pointed out that this risk stratification is relative, and each level overlaps and converts each other, but dynamic observation and dynamic assessment must be carried out throughout the entire treatment process of heart failure, including determining whether the heart failure is aggravating, The etiology and incentives of heart failure aggravation, as well as the severity of the disease, and adjust the management and treatment plan accordingly to achieve early diagnosis and early treatment.
In terms of non-drug therapy, the “Consensus” states that cardiac resynchronization therapy, rhythm control for atrial fibrillation, pacing therapy for atrial fibrillation, and ablation therapy for ventricular arrhythmias can improve the symptoms of patients with aggravated heart failure. and prognosis.
Prevention before the disease, both disease prevention and change. At the “Consensus” conference, the participating experts re-emphasized that the prevention and treatment of chronic heart failure exacerbation are equally important, and standardized drug treatment should be carried out in accordance with guidelines and consensus, identifying high-risk groups, and strengthening follow-up management and patient education.