medicina59巻12号

2022年11月発行

特集 避けて通れない心不全診療—総合内科力・循環器力を鍛えよう！

心不全総論

患者中心の心不全診療を目指して—予後予測モデルの上手な使い方

著者： 白石泰之¹

所属機関： ¹慶應義塾大学医学部循環器内科

ページ範囲：P.2118 - P.2122

文献概要

Point
◎「治癒でなく，病気とともに生きる」ことが前提のなかで，「患者中心の心不全診療」の意義はきわめて大きい．
◎最適な治療方針の決定のために，患者・家族と予後情報まで含めた質の高いshared decision making（SDM）が必要である．
◎心不全においては，医療者や患者自身の「主観的な」予後予測の信頼性は一般的に低く，リスクモデルによる「客観的な」予後予測が有用である．
◎心不全患者に予後情報を伝えるときは，心不全の病の軌跡を考慮して，ある程度の幅をもたせて伝えるべきである．

参考文献

1）GBD 2017 disease and Injury Incidence and Prevalence Collaborators：Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017；A systematic analysis for the Global Burden of Disease Study 2017. Lancet 392：1789-1858, 2018

2）Tromp J, et al：Post-discharge prognosis of patients admitted to hospital for heart failure by world region, and national level of income and income disparity（REPORT-HF）；A cohort study. Lancet Glob Health 8：e411-e422, 2020

3）Shiraishi Y, et al：Outcome of hospitalised heart failure in Japan and the United Kingdom stratified by plasma N-terminal pro-B-type natriuretic peptide. Clin Res Cardiol 107：1103-1110, 2018

4）Shiraishi Y, et al：9-Year trend in the management of acute heart failure in Japan；A report from the National Consortium of Acute Heart Failure Registries. J Am Heart Assoc 7：e008687, 2018

5）Ide T, et al：Clinical characteristics and outcomes of hospitalized patients with heart failure from the large-scale Japanese registry of acute decompensated heart failure（JROADHF）. Circ J 85：1438-1450, 2021

6）Kitai T, et al：Mode of death among Japanese adults with heart failure with preserved, midrange, and reduced ejection fraction. JAMA Netw open 3：e204296, 2020

7）Levy WC, et al：The Seattle Heart Failure Model：prediction of survival in heart failure. Circulation 113：1424-1433, 2006

8）Shiraishi Y, et al：Validation and recalibration of Seattle Heart Failure Model in Japanese acute heart failure patients. J Card Fail 25：561-567, 2019

9）Seattle Heart Failure Model Calculator（日本人患者対応版）.　https://jcvsd.org/WET2_SHFM/WET2_SHFM（2022年9月閲覧）

10）Pocock SJ, et al：Predicting survival in heart failure；A risk score based on 39372 patients from 30 studies. Eur Heart J 34：1404-1413, 2013

11）Sawano M, et al：Performance of the MAGGIC heart failure risk score and its modification with the addition of discharge natriuretic peptides. ESC Heart Fail 5：610-619, 2018

12）Mcllvennan CK, et al：Palliative care in patients with heart failure. BMJ 353：i1010, 2016

13）Heidenreich PA, et al：2022 AHA/ACC/HFSA guideline for the management of heart failure；Executive summary；A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 145：e876-e894, 2022

14）McDonagh TA, et al：2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 42：3599-3726, 2021

15）Kitakata H, et al：Prognostic understanding and preference for the communication process with physicians in hospitalized heart failure patients. J Card Fail 27：318-326, 2021

16）Lunney JR, et al：Profiles of older medicare decedents. J Am Geriatr Soc 50：1108-1112, 2002

17）Alba AC, et al. Risk prediction models for mortality in ambulatory patients with heart failure；A systematic review. Circ Heart Fail 6：881-889, 2013

18）Stevenson LW, O'Donnell A：Advanced care planning；Care to plan in advance. JACC Heart Fail 3：122-126, 2015