瑞典HFrEF患者四联药物治疗的依从性与持续性研究
结果显示2023年四联治疗使用率达60%，主要受限于MRA使用率较低（73%）。对BB、RASi/ARNi和MRA的良好依从性与持续性及对SGLT2i的良好依从性与心衰住院/心血管死亡的较低风险独立相关。
要点
- 2023年瑞典HFrEF患者四联治疗使用率达60%，MRA使用率最低为73%。
- 四联治疗整体依从性为85%、持续性为67%，各药物依从性均≥90%。
- 良好依从性与持续性与较低的心衰住院/心血管死亡风险相关。
核心结论
- 至2023年四联治疗使用率达约60%，主要受限于MRA使用率较低（约73%）。
- 患者对基础治疗的依从性较高，且似乎与更好的预后相关。
- 实际心衰诊疗中四联药物治疗的使用率与依从性改善是可实现的，但剂量不理想和频繁停药仍是待改进领域。
研究设计与样本
- 中位年龄74岁（四分位距64-80岁），28%为女性。
- 利用药房续药数据，将覆盖天数比例≥80%归为依从，将索引后12±2个月内有配药记录归为持续。
主要发现
- 2016年至2023年期间四类HFrEF基础治疗的使用率均有所上升。
- 2023年BB使用率93%、RASi/ARNi使用率95%、MRA使用率73%、SGLT2i使用率83%、四联治疗使用率60%。
- BB依从性95%和持续性90%，RASi/ARNi依从性95%和持续性89%，MRA依从性90%和持续性77%，SGLT2i依从性94%和持续性86%，四联治疗依从性85%和持续性67%。
- 对BB、RASi/ARNi和MRA的良好依从性与持续性及对SGLT2i的良好依从性与较低的心衰住院/心血管死亡独立相关。
关键数值与推荐
- 2023年四联治疗使用率60%，其中MRA使用率73%为最低单项。
- 依从性定义为覆盖天数比例≥80%，持续性定义为索引后12±2个月内有配药记录。
临床怎么用
- 临床应关注MRA的启用，因其为限制四联治疗达标的主要环节。
- 对已启用的基础治疗需持续关注患者依从性与持续性，尤其是MRA和SGLT2i。
- 提高四联治疗使用率与依从性有助于改善HFrEF患者预后。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
BACKGROUND AND AIMS: Real-world uptake of heart failure with reduced ejection fraction (HFrEF) treatments relies on physician prescriptions but also on patient adherence. This study assessed implementation of, patient adherence and persistence with quadruple HFrEF therapy in the contemporary setting, and associations with morbidity/mortality. METHODS: Patients with HFrEF enrolled in the Swedish Heart Failure Registry between January 2016 and December 2023 were included. Using pharmacy refills, patients with ≥80% proportion of days covered were categorized as adherent and with dispensations at 12 ± 2 months post-index as persistent. RESULTS: In 35 215 patients with HFrEF [median age 74 (interquartile range 64-80) years; 28% female], use of all four HFrEF foundational therapies increased between 2016 and 2023: in 2023, 93% used beta-blockers (BB), 95% renin-angiotensin-system inhibitors (RASi)/angiotensin receptor-neprilysin inhibitors (ARNi), 73% mineralocorticoid receptor antagonists (MRA), 83% sodium-glucose co-transporter 2 inhibitors (SGLT2i), and 60% quadruple therapy. The proportion of patients who were adherent and persistent, respectively, to BB was 95% and 90%, RASi/ARNi 95% and 89%, MRA 90% and 77%, SGLT2i 94% and 86%, and quadruple therapy 85% and 67%. Good adherence and persistence for BB, RASi/ARNi, and MRA and good adherence for SGLT2i were independently associated with lower heart failure hospitalization/cardiovascular death. CONCLUSIONS: By 2023, use of quadruple therapy reached ∼60%, being mostly limited by lower adoption of MRA (∼73%). Patient adherence to foundational therapies was high and appeared associated with better prognosis. These data suggest that improvements in the uptake of and adherence to quadruple HFrEF pharmacotherapy are achievable in real-word heart failure care, although suboptimal dosing and frequent discontinuations remain important areas of further implementation.
引用
- Lindberg, Uijl, Benson, et al. Heart failure with reduced ejection fraction in Sweden: patient adherence and persistence to quadruple pharmacotherapy prescription. Eur Heart J. 2026. PMID: 41920862. doi:10.1093/eurheartj/ehag199
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。