年美国心力衰竭管理指南心衰指南课件.ppt

Cardiac Transplantation Evaluation for cardiac transplantation is indicated for carefully selected patients with stage D HF despite GDMT, device, and surgical management. I IIa IIb III The Hospitalized Patient Guideline for HF Precipitating Causes of Decompensated HF The Hospitalized Patient Precipitating Causes of Decompensated HF ACS precipitating acute HF decompensation should be promptly identified by ECG and serum biomarkers including cardiac troponin testing, and treated optimally as appropriate to the overall condition and prognosis of the patient. Common precipitating factors for acute HF should be considered during initial evaluation, as recognition of these conditions is critical to guide appropriate therapy. I IIa IIb III I IIa IIb III Maintenance of GDMT During Hospitalization The Hospitalized Patient Maintenance of GDMT During Hospitalization In patients with HFrEF experiencing a symptomatic exacerbation of HF requiring hospitalization during chronic maintenance treatment with GDMT, it is recommended that GDMT be continued in the absence of hemodynamic instability or contraindications. Initiation of beta-blocker therapy is recommended after optimization of volume status and successful discontinuation of intravenous diuretics, vasodilators, and inotropic agents. Beta-blocker therapy should be initiated at a low dose and only in stable patients. Caution should be used when initiating beta blockers in patients who have required inotropes during their hospital course. I IIa IIb III I IIa IIb III Pharmacological Treatment for Stage C HFrEF (cont.) Long-term use of infused positive inotropic drugs is potentially harmful for patients with HFrEF, except as palliation for patients with end-stage disease who cannot be stabilized with standard medical treatment (see recommendations for stage D). Calcium channel blocking drugs are not recommended as routine treatment for patients with HFrEF. Harm I IIa IIb III I IIa IIb III No Benefit Pharmacological Treatme