在“2018深圳心力衰竭国际发展论坛暨心力衰竭治疗研讨会·深圳站”会议上，来自台湾振兴医院的張鴻猷教授为我们带来了“台湾心衰登录研究结果分析”的精彩报告。

 

 

Heart Failure is a Major and GrowingPublic Health Problem

 

Heart failure in Taiwan: Prevalence

—Chin-Shan communitycardiovascular cohort, 2660 subjects (1991-1992)—The prevalence of HFwas 5.5%: 4.6% for HFpEF; 0.9% for HFrEF (LVEF<55%)

 

Incidence of HF hospitalization, 2005

 

Heart failure in Taiwan: hospitalization

 

Cumulative benefit of GDMT (and CRT) inHF

 

Heart failure is deadlier than many cancers

 

Heart failure in Taiwan: outcomes

 

Taiwan Society of Cardiology Heart Failure with reduced Ejection Fraction registry (TSOC-HFrEF)

• Prospective,multicenter, observational survey

• Studydesign: 

◇ Patientsadmitted for acute, pre-existed or new onset HF with LVEF ≤ 40%

◇ Enrolled from May 2013 toOctober 2014

◇ Follow-upstatus was collected at the 6th month and the 12th month after the entry visit

 

Characteristics at Admission

 

Primary Etiology of Heart Failure

 

Clinical presentations

 

Possible Precipitating Factors

 

 

Median Length of Stay

 

In-Hospital Mortality

 

Guideline Directed Medical Therapy at discharge

 

TSOC-HFrEF registry outcomes

1-yr Re-hospitalization rates for HF: 38.5%

At 1-yr, 46.4% were free from death, hospitalization forHF, LVAD or transplantation

 

 

BNP but not NT-proBNPpredicts outcomes in TSOC-HFrEF registry

 

Effect of renal dysfunction on BNP, NT-proBNP andtheir ratio

 

ST2 is Not Correlated with RenalFunction

In a cohort of 879 heart failure patients ST2 did notshow any correlation with renal function whereas NT-proBNP concentrationsincreased significantly with decreasing renal function.

 

ST2 Predicts Mortality in ADHF

在急性心脏不良事件后：

ST2能提供咨询很快的辨认出短期内(30天)高风险的患者,而且ST2提供的预后咨询能持续到一年以上

 

Target Dose and Mortality

 

Reluctance to up-titrate all GDMTs

经过一年的追踪，仅1/4 病人up-titrateRAS blocker 及MRA 剂量，不到 40% 病人 up-titrate Beta blocker 剂量

 

What we learned from TSOC-HFrEF registry

• —Although in-hospitalmortality rate was low (2.4%), mortality and readmission rates were high during1-yr follow-up——

• This registrydemonstrated the underutilization of guideline-recommended medications andreluctance to up-titrate them to target dose——

• Due to high incidenceof renal impairment, ST2 should be a better biomarker for our patients