medicina57巻10号

2020年09月発行

特集 循環器診療2020—どこまで攻めて，どこから引くか？ 画像診断・その他

心不全在宅診療の時代を迎えてEBMを考える

著者： 横山広行¹

所属機関： ¹横山内科循環器科医院

ページ範囲：P.1751 - P.1755

Point
◎心不全在宅診療では，入院中の治療をシームレスに外来で継続することが重要である．
◎包括的疾病管理プログラムと退院後の看護師による訪問診療により心不全再入院率が減少する．
◎高齢者や多疾病合併心不全患者，HFpEF（左室駆出率の保たれた心不全）症例では包括的疾病管理の効果は限定的なため，症例の特性に合った介入が必要である．
◎退院早期の心不全増悪によるうっ血には，外来でループ利尿薬を静脈内・皮下投与する．
◎高齢心不全患者の在宅診療では，かかりつけ医はACP（アドバンス・ケア・プランニング）を導入する努力が求められる．

参考文献

1）日本心不全学会ガイドライン委員会（編）：高齢心不全患者の治療に関するステートメント．日本心不全学会，2016 http://www.asas.or.jp/jhfs/pdf/Statement_HeartFailurel.pdf（2020年7月閲覧）

2）Rich MW, et al：A multidisciplinary intervention to prevent the readmission of elderly patients with congestive heart failure. N Engl J Med 333：1190-1195, 1995

3）日本循環器学会．循環器疾患の診断と治療に関するガイドライン：慢性心不全治療ガイドライン（2010年改訂版），2010

4）Tsuchihashi-Makaya M, et al：Home-based disease management program to improve psychological status in patients with heart failure in Japan. Circ J 77：926-933, 2013

5）Jaarsma T, et al：Effect of moderate or intensive disease management program on outcome in patients with heart failure；Coordinating Study Evaluating Outcomes of Advising and Counseling in Heart Failure（COACH）. Arch Intern Med 168：316-324, 2008

6）Angermann CE, et al：Mode of action and effects of standardized collaborative disease management on mortality and morbidity in patients with systolic heart failure；The Interdisciplinary Network for Heart Failure（INH）study. Circ Heart Fail 5：25-35, 2012

7）Stewart S, et al：Impact of home versus clinic-based management of chronic heart failure；The WHICH? （Which Heart Failure Intervention Is Most Cost-Effective ＆ Consumer Friendly in Reducing Hospital Care）multicenter, randomized trial. J Am Coll Cardiol 60：1239-1248, 2012

8）Yancy CW, et al：2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure；A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. J Card Fail 23：628-651, 2017

9）Ponikowski P, et al：2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure：The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology（ESC）Developed with the special contribution of the Heart Failure Association（HFA）of the ESC. Eur Heart J 37：2129-2200, 2016

10）Van Spall HGC, et al：Comparative effectiveness of transitional care services in patients discharged from the hospital with heart failure；A systematic review and network meta-analysis. Eur J Heart Fail 19：1427-1443, 2017

11）Feltner C, et al：Transitional care interventions to prevent readmissions for persons with heart failure；A systematic review and meta-analysis. Ann Intern Med 160：774-784, 2014

12）Salive ME：Multimorbidity in older adults. Epidemiol Rev. 35：75-83, 2013

13）Kalogirou F, et al：Heart failure disease management；A systematic review of effectiveness in heart failure with preserved ejection fraction. ESC Heart Fail 7：194-212, 2020

14）Chan YK, et al：Applying heart failure management to improve health outcomes；But WHICH One? Card Fail Rev 3：113-115, 2017

15）Stewart S, et al：Impact of nurse-led, multidisciplinary home-based intervention on event-free survival across the spectrum of chronic heart disease；Composite analysis of health outcomes in 1226 patients from 3 randomized trials. Circulation 133：1867-1877, 2016

16）Whitty JA, et al：Patient preferences and willingness-to-pay for a home or clinic based program of chronic heart failure management；Findings from the Which? trial. PLoS One 8：e58347, 2013

17）Ryder M, et al：Outpatient intravenous diuretic therapy；Potential for marked reduction in hospitalisations for acute decompensated heart failure. Eur J Heart Fail 10：267-272, 2008

18）Ota KS, et al：Physician-directed heart failure transitional care program；A retrospective case review. J Clin Med Res 5：335-342, 2013

19）Hernandez AF, et al：Relationship between early physician follow-up and 30-day readmission among Medicare beneficiaries hospitalized for heart failure. JAMA 303：1716-1722, 2010

20）Buckley LF, et al：Intravenous diuretic therapy for the management of heart failure and volume overload in a multidisciplinary outpatient unit. JACC Heart Fail 4：1-8, 2016

21）Gilotra NA, et al：Efficacy of intravenous furosemide versus a novel, pH-neutral furosemide formulation administered subcutaneously in outpatients with worsening heart failure. JACC Heart Fail 6：65-70, 2018

22）Wierda E, et al：Outpatient treatment of worsening heart failure with intravenous and subcutaneous diuretics；A systematic review of the literature. ESC Heart Fail 7：892-902, 2020

23）Dickstein K, et al：ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008；The Task Force for the diagnosis and treatment of acute and chronic heart failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC（HFA）and endorsed by the European Society of Intensive Care Medicine（ESICM）. Eur J Heart Fail 10：933-989, 2008

24）Hunt SA, et al：2009 focused update incorporated into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults；A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines：Developed in collaboration with the International Society for Heart and Lung Transplantation. Circulation 119：e391-479, 2009

25）Kuragaichi T, et al：Nationwide survey of palliative care for patients with heart failure in Japan. Circ J 82：1336-1343, 2018

26）Hamatani Y, et al：Development and practical test of quality indicators for palliative care in patients with chronic heart failure. Circ J 84：584-591, 2020

27）Nishikawa Y, et al：Advance care planning for adults with heart failure. Cochrane Database Syst Rev 2：CD013022, 2020