慢性心力衰竭“新四联”药物治疗临床决策路径专家共识  

Expert Consensus on Decision-making Pathway for Quadruple Pharmacotherapy Management of Chronic Heart Failure

作　　者：中国医师协会心血管内科医师分会 中国心衰中心联盟 《慢性心力衰竭“新四联”药物治疗临床决策路径专家共识》工作组 葛均波[2] 霍勇[3] 杨杰孚[4] 高秀芳[5] 李勇[5] Chinese College of Cardiovascular Physicians;Chinese Heart Failure Center Alliance;The Task Force for Expert Consensus Decision Pathway for Quadruple Pharmacotherapy Management of Chronic Heart Failure

机构地区：[1]不详 [2]复旦大学附属中山医院 [3]北京大学第一医院 [4]北京医院 [5]复旦大学附属华山医院

出　　处：《中国循环杂志》2022年第8期769-781,共13页Chinese Circulation Journal

摘　　要：中国慢性心力衰竭(心衰)患病率持续上升,对民众健康造成极大危害。大型临床研究结果证实,血管紧张素受体脑啡肽酶抑制剂(ARNI)或血管紧张素转换酶抑制剂/血管紧张素Ⅱ受体拮抗剂、钠-葡萄糖共转运蛋白2抑制剂(SGLT2i)、β受体阻滞剂和盐皮质激素受体拮抗剂为基础的“新四联”规范化心衰药物治疗模式,能够大幅度改善射血分数降低的心衰患者预后。而SGLT2i和ARNI能够显著改善射血分数保留的心衰患者预后。本共识提出简洁明了的慢性心衰药物治疗临床决策路径,着重阐述“新四联”药物的启动顺序、启动时机、使用剂量及调整原则、临床注意事项等,强调对慢性心衰患者院内-院外的全程、长期管理,以促进广大临床医师更规范地应用改善心衰预后药物,以期降低中国慢性心衰患者的住院率和死亡率,减轻心衰所造成的社会经济负担。The prevalence of chronic heart failure(CHF)in China is rising steeply in recent years,which leads to increasing adverse impacts on people's health.Randomized cardiovascular outcome clinical trials have demonstrated the efficacy of an optimal treatment based on the“Quadruple Therapy”,a combination of angiotensin receptor neprilysin inhibitors(ARNIs)or angiotensin-converting enzyme inhibitors/angiotensin receptor blockers(ACEIs/ARBs),sodium-glucose cotransporter 2 inhibitors(SGLT2is),beta-blockers(BBs)and mineralocorticoid receptor antagonists(MRAs),for improving the clinical prognosis of patients with heart failure with reduced ejection fraction(HFrEF).Simultaneously,SGLT2is and ARNIs can also improve the clinical prognosis of patients with heart failure with preserved ejection fraction(HFpEF).This expert consensus proposes a simple and clear clinical decision-making pathway for pharmacotherapy management of CHF,emphasizing the proper sequencing and initiation timing of the“Quadruple Therapy”drugs,dosage and adjustment principles,clinical precautions,as well as the long-term management of both inpatients and outpatients diagnosed with CHF.This consensus is expected to promote physicians to treat patients with standardized outcome-improving therapy,thus decreasing the hospitalization and mortality of CHF patients as well as alleviating the financial burden caused by CHF.

关 键 词：心力衰竭 血管紧张素受体脑啡肽酶抑制剂 钠-葡萄糖共转运蛋白2抑制剂 Β受体阻滞剂 盐皮质激素受体拮抗剂 

分 类 号：R54[医药卫生—心血管疾病]