Mwoyo kutadza kutarisirwa kwakavandudzwa nekupindira kwekuita pane outpatient cardiology maitiro
Mwoyo kutadza kutarisirwa kwakavandudzwa nekupindira kwekuita pane outpatient cardiology maitiro
Anonim

Chidzidzo chakatungamirwa neUCLA chakaedza kupindira kutsva kwekuita kubatsira kuvandudza kutevedzera gwara renyika-rakakurudzirwa marapirwo evarwere vemoyo muchipatara.

Kukundikana kwemoyo chirwere chisingaperi, chinoenderera mberi chinokanganisa mamirioni uye chinoguma nekurwara kwakanyanya, kufa uye kushandiswa kwehutano hwakakosha zviwanikwa uye mutengo. Kunyangwe tsvakiridzo yesainzi uye nhungamiro yenyika zvakaratidza kushanda kwekurapa kwakananga, marapirwo aya achiri kushandiswa zvishoma.

Kunyange zvazvo mapurogiramu akawanda akabatsira kuvandudza kutadza kwemoyo kuchengetwa kwevarwere muchipatara, iyi ndiyo huru yekupindira kwehutano hwekuita pamusoro pekushandiswa kwemitemo yenyika-inokurudzirwa kurapwa mune imwe nzvimbo yekiriniki yekunze.

Yakashumwa muChikunguru 26 online edition yeKutenderera, chirongwa chitsva chakapa kupindira kwakakosha kunosanganisira maturusi ekutsigira sarudzo yekiriniki, nzira dzekuvandudza dzakarongeka, uye kuongororwa kwechati chekurapa nemhinduro yekubatsira varapi kupa zvirinani kurapa kwekutadza kwemoyo kwakaratidza kuvandudza kurarama kwemurwere nezvimwe. mhedzisiro yekiriniki.

"Takawana kuvandudzwa kwakakura, kuchipatara kwakakosha muhuwandu hwevarwere vemoyo vanotadza kuwana marapirwo akakosha mushure mekutanga chirongwa ichi chitsva chekuvandudza mashandiro ekuita pamabasa emoyo wemoyo," akadaro munyori wekutanga Dr. Gregg Fonarow, Eliot Corday Purofesa weCardiovascular Medicine neSainzi uye mutungamiriri, Ahmanson-UCLA Cardiomyopathy Center, David Geffen Chikoro cheMishonga paUCLA.

Pachidzidzo ichi, vatsvakurudzi vakashandisa chirongwa chitsva chinodaidzwa kuti Registry Kuvandudza Kushandiswa kweEvidence-Based Heart Failure Therapies muOutpatient Setting (IMPROVE HF) pa167 cardiology practice makiriniki muUnited States. Vatori vechikamu vaisanganisira 34, 810 varwere vakaonekwa vaine chirwere chemoyo chekare, kunetesa basa remoyo wekuruboshwe, kana kusagadzikana kwemoyo, chinova chiitiko chinoitika kana moyo weruboshwe ventricle usingachakwanise kupomba ropa rakakwana kune dzimwe nhengo dzemuviri.

Chirongwa ichi chakashandisa kupindira kubatsira kuona kuti varwere vekutadza kwemoyo vakagashira zvinomwe zverudzi rwekurapwa nhanho yekurapwa sezvakakurudzirwa mugwara rekutadza kwemoyo rakagadzirwa neAmerican College of Cardiology neAmerican Heart Association.

Iyo IMPROVE HF chirongwa chakashandisa kit chekushandisa kubatsira varapi kuita sarudzo dzekutarisira varwere izvo zvaisanganisira kudzidzisa, kuita profiling, zviyeuchidzo masisitimu, tsika-chaiyo data, mhando yemishumo yekuchengeta, gwara-based best practice algorithms, akamisikidzwa kusangana mafomu, cheki, homwe. makadhi nezvinamira pamachati evarwere.

Ongororo yechati yezvokurapa yakaitwa panguva yekutanga isati yatora chirongwa uye panguva dzakati wandei kusvika kumakore maviri mushure mekutangwa kweIMPROVE HF chirongwa chakaratidza kuvandudzwa kukuru mukushandiswa kwezvishanu zvehumwe humbowo-hwakavakirwa, nhungamiro yenyika-inokurudzirwa marapirwo ekutadza kwemoyo anonangwa mu. chidzidzo chacho. Vatsvakurudzi vakawana:

* Kushandiswa kwemishonga yeBeta blocker kwakawedzera 6.2 muzana, kubva pa86 muzana pakutanga kusvika ku92.2 muzana mushure mekupindira.

* Aldosterone antagonist mishonga inoshandiswa yakasimuka 25.1 muzana, ichiwedzera kubva ku34. 5 kusvika ku60.3 muzana.

* Cardiac resynchronization therapy, mudziyo unobatsira kubatanidza kubanda kwemwoyo, wakanga une kushandiswa kwakawedzera kwe29,9 muzana, kubva pa37,2 muzana pakutanga kusvika pa66,3 muzana.

* Kushandiswa kwemichina inoiswa cardioverter-defibrillator, iyo inobatsira nguva dzose kumhanya kweabnormal heartbeats, yakawedzera 27,4 muzana, kubva pa50,1 kusvika ku77,5 muzana.

* Dzidzo yevarwere vemwoyo yakakwirawo 12,6 muzana, kubva pa59,5 kusvika pa72,1 muzana.

"Takaratidza kuwedzera kushandiswa kwehuwandu hwemishonga inokurudzirwa-inokurudzirwa yakaongororwa muchidzidzo," akadaro Fonarow.

Akacherechedza kuti zvachose, mikana yekupa nyika nhungamiro-inokurudzirwa marapirwo kune varwere vakakodzera yakawedzera kubva ku68. 4 muzana pakutanga kusvika ku80.1 muzana pamakore maviri mushure mekutanga IMPROVE HF kupindira.

Maererano nevatsvakurudzi, kuwedzera uku kwakakosha, kunyanya kupiwa maitiro akawanda ehutano hwemwoyo munyika yose yakabatanidzwa muchidzidzo, ruzhinji rwacho rwakanga rwuri munharaunda.

"Chirongwa cheIMPROVE HF chinogona kubatsira kumisikidza modhi nehurongwa hwezvirongwa zvekuvandudza mashandiro emangwana zvinopihwa munzvimbo yekunze yekurapa kwemoyo," akawedzera Fonarow.

Kuratidzwa kwekuchinja kukuru mukushandiswa kwegwara-inokurudzirwa marapirwo pakati pemaitiro anotora chikamu muIMPROVE HF inopa humbowo hwakananga mukutsigira kushandisa izvi kana zvirongwa zvemagadzirirwo akafanana munyika yose.

Fonarow akawedzera kuti, "Chidzidzo ichi chinoratidza kuti kugamuchirwa kwehutano hwehutano hwevarwere hunoita sechinhu chinonyanya kukosha chekuedza kwekuvandudza kushanda kwemoyo. vashandi uye zviwanikwa mukati memaitiro ega ega, zvingave zvakanyanya scalable uye zvakatsiga pane mamwe mamodheru ekuvandudza kunze kwemoyo kuchengetwa kwemoyo."

Hapana kuvandudzwa kwakakosha kwakaonekwa kune maviri emitemo yenyika marapirwo akashandiswa muchidzidzo: mushonga wekutadza kwemoyo unonzi angiotensin-converting enzyme inhibitor/angiotensin receptor blocker kana kushandisa mushonga weanticoagulation weatrial fibrillation.

Vatsvakurudzi vanoti izvi zvinogona kunge zvakakonzerwa nemafungiro echiremba, kusagadzikana kunobatanidza nekutarisa mamwe mishonga kana zvimwe zvinhu. Kumwe kudzidza kunodiwa kuongorora kuti sei kushandiswa kwemishonga miviri iyi isina kuita nani.

Yakakurumbira nenyaya