medicina60巻2号

2023年02月発行

特集 慢性疾患診療のお悩みポイントまとめました—高血圧からヘルスメンテナンスまで 慢性心不全

慢性心不全の増悪を防ぐにはどうすればいいですか？

著者： 小野雅敬¹² 官澤洋平³

所属機関： ¹関西医科大学香里病院総合診療科 ²関西医科大学総合診療医学講座 ³明石医療センター総合内科

ページ範囲：P.318 - P.325

Point
◎ハードエンドポイントである生命予後改善のみならず，ソフトエンドポイントである再入院予防も大切な治療目標となる．
◎患者本人の理解や価値観を尊重した臨床決定や，患者や家族の積極的な参加を促し支援することも重要である．
◎高齢者では特に併存疾患管理や心臓リハビリテーション，多職種連携が重要となる．
◎再入院は退院後早期に多く，移行期ケアに最大の注意を払う．

参考文献

1）Hamaguchi S, et al：Predictors of long-term adverse outcomes in elderly patients over 80 years hospitalized with heart failure；A report from the Japanese Cardiac Registry of Heart Failure in Cardiology（JCARE-CARD）. Circ J 75：2403-2410, 2011

2）Tsuchihashi M, et al：Clinical characteristics and prognosis of hospitalized patients with congestive heart failure；A study in Fukuoka, Japan. Jpn Circ J 64：953-959, 2000

3）Hollenberg SM, et al：2019 ACC expert consensus decision pathway on risk assessment, management, and clinical trajectory of patients hospitalized with heart failure；A report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol 74：1966-2011, 2019

4）Ouwerkerk W, et al：Determinants and clinical outcome of uptitration of ACE-inhibitors and beta-blockers in patients with heart failure；A prospective European study. Eur Heart J 38：1883-1890, 2017

5）Cautela J, et al：Management of low blood pressure in ambulatory heart failure with reduced ejection fraction patients. Eur J Heart Fail 22：1357-1365, 2020

6）Akita K, et al：Current use of guideline-based medical therapy in elderly patients admitted with acute heart failure with reduced ejection fraction and its impact on event-free survival. Int J Cardiol 235：162-168, 2017

7）Yancy CW, et al：2017 ACC expert consensus decision pathway for optimization of heart failure treatment；Answers to 10 pivotal issues about heart failure with reduced ejection fraction；A report of the American College of Cardiology Task Force on expert consensus decision pathways. J Am Coll Cardiol 71：201-230, 2018

8）Hori M, et al：Low-dose carvedilol improves left ventricular function and reduces cardiovascular hospitalization in Japanese patients with chronic heart failure；The Multicenter Carvedilol Heart Failure Dose Assessment（MUCHA）trial. Am Heart J 147：324-330, 2004

9）Ferreira JP, et al：Abnormalities of potassium in heart failure；JACC State-of-the-Art review. J Am Coll Cardiol 75：2836-2350, 2020

10）Komajda M, et al：Physicians' adherence to guideline-recommended medications in heart failure with reduced ejection fraction；Data from the QUALIFY global survey. Eur J Heart Fail 18：514-522, 2016

11）Rossignol P, et al：Unravelling the interplay between hyperkalaemia, renin-angiotensin-aldosterone inhibitor use and clinical outcomes；Data from 9222 chronic heart failure patients of the ESC-HFA-EORP Heart Failure Long-Term Registry. Eur J Heart Fail 22：1378-1389, 2020

12）Masuyama T, et al：Superiority of long-acting to short-acting loop diuretics in the treatment of congestive heart failure. Circ J 76：833-842, 2012

13）Leventhal MJE, et al：Negotiating compliance in heart failure；Remaining issues and questions. Eur J Cardiovasc Nurs 4：298-307, 2005

14）Haynes RB, et al：Can simple clinical measurements detect patient noncompliance? Hypertension 2：757-764, 1980

15）Ruppar TM, et al：Medication adherence interventions improve heart failure mortality and readmission rates；Systematic review and meta-analysis of controlled trials. J Am Heart Assoc 5：e002606, 2016

16）Rochon PA, Gurwitz JH：Optimising drug treatment for elderly people；The prescribing cascade. BMJ 315：1096-1099, 1997

17）Amabile CM, Spencer AP：Keeping your patient with heart failure safe；A review of potentially dangerous medications. Arch Intern Med 164：709-720, 2004

18）Alvarez PA, et al：Potentially harmful drug prescription in elderly patients with heart failure with reduced ejection fraction. ESC Heart Fail 7：1862-1871, 2020

19）Schiff GD, et al：Decompensated heart failure；Symptoms, patterns of onset, and contributing factors. Am J Med 114：625-630, 2003

20）Wang L, et al：Accuracy of ultrasound jugular venous pressure height in predicting central venous congestion. Ann Intern Med 175：344-351, 2022

21）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

22）Ezekowitz JA, et al：Reduction of dietary sodium to less than 100 mmol in heart failure（SODIUM-HF）；An international, open-label, randomised, controlled trial. Lancet 399：1391-1400, 2022

23）Cooper RM, et al：The effect of age on taste sensitivity. J Gerontol 14：56-58, 1959

24）Holst M, et al：Liberal versus restricted fluid prescription in stabilised patients with chronic heart failure；Result of a randomised cross-over study of the effects on health-related quality of life, physical capacity, thirst and morbidity. Scand Cardiovasc J 42：316-322, 2008

25）Castro-Gutiérrez V, Rada G：Is fluid restriction needed in heart failure? Medwave 17（Suppl-1）：e6817, 2017

26）Caton JB, et al：Things we do for no reasonTM；Fluid restriction for the management of acute decompensated heart failure in patients with reduced ejection fraction. J Hosp Med 16：754-756, 2021

27）Seligmann H, et al：Thiamine deficiency in patients with congestive heart failure receiving long-term furosemide therapy；A pilot study. Am J Med 91：151-155, 1991

28）Rieck J, et al：Urinary loss of thiamine is increased by low doses of furosemide in healthy volunteers. J Lab Clin Med 134：238-243, 1999

29）Keith ME, et al：B-vitamin deficiency in hospitalized patients with heart failure. J Am Diet Assoc 109：1406-1410, 2009

30）Hanninen SA, et al：The prevalence of thiamin deficiency in hospitalized patients with congestive heart failure. J Am Coll Cardiol 47：354-361, 2006

31）Jain A, et al：Determining the role of thiamine deficiency in systolic heart failure；A meta-analysis and systematic review. J Card Fail 21：1000-1007, 2015

32）Katta N, et al：Does long-term furosemide therapy cause thiamine deficiency in patients with heart failure? A focused review. Am J Med 129：753.e7-753.e11, 2016

33）DiNicolantonio JJ, et al：Thiamine supplementation for the treatment of heart failure；A review of the literature. Congest Heart Fail 19：214-222, 2013

34）Desai AS：The three-phase terrain of heart failure readmissions. Circ Heart Fail 5：398-400, 2012

35）Dharmarajan K, et al：Trajectories of risk after hospitalization for heart failure, acute myocardial infarction, or pneumonia；Retrospective cohort study. BMJ 350：h411, 2015

36）Phelan D, et al：Can we reduce preventable heart failure readmissions in patients enrolled in a Disease Management Programme? Ir J Med Sci 178：167-171, 2009

37）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

38）Vedel I, Khanassov V：Transitional care for patients with congestive heart failure；A systematic review and meta-analysis. Ann Fam Med 13：562-571, 2015

39）Al-Damluji MS, et al：Hospital variation in quality of discharge summaries for patients hospitalized with heart failure exacerbation. Circ Cardiovasc Qual Outcomes 8：77-86, 2015

40）Kinugasa Y, et al：Differences in priorities for heart failure management between cardiologists and general practitioners in Japan. Circ J 85：1565-1574, 2021

41）Halasyamani L, et al：Transition of care for hospitalized elderly patients；Development of a discharge checklist for hospitalists. J Hosp Med 1：354-360, 2006

42）Bodagh N, Farooqi F：Improving the quality of heart failure discharge summaries. Br J Cardiol 24：75-78, 2017

43）Hamaguchi S, et al：Anemia is an independent predictor of long-term adverse outcomes in patients hospitalized with heart failure in Japan；A report from the Japanese Cardiac Registry of Heart Failure in Cardiology（JCARE-CARD）. Circ J 73：1901-1908, 2009

44）Okuno K, et al：Effective blood hemoglobin level to predict prognosis in heart failure with preserved left ventricular ejection fraction；Results of the Japanese heart failure syndrome with preserved ejection fraction registry. Heart Vessels 34：1168-1177, 2019

45）Swedberg K, et al：Treatment of anemia with darbepoetin alfa in systolic heart failure. N Engl J Med 368：1210-1219, 2013

46）Rocha BML, et al：The burden of iron deficiency in heart failure；Therapeutic approach. J Am Coll Cardiol 71：782-793, 2018

47）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

48）Lewis GD, et al：Effect of oral iron repletion on exercise capacity in patients with heart failure with reduced ejection fraction and iron deficiency；The IRONOUT HF randomized clinical trial. JAMA 317：1958-1966, 2017

49）Ponikowski P, et al：Ferric carboxymaltose for iron deficiency at discharge after acute heart failure；A multicentre, double-blind, randomised, controlled trial. Lancet 396：1895-1904, 2020

50）Anker SD, et al：Ferric carboxymaltose in patients with heart failure and iron deficiency. N Engl J Med 361：2436-2448, 2009

51）Yoshihisa A, Takeishi Y：Sleep disordered breathing and cardiovascular diseases. J Atheroscler Thromb 26：315-327, 2019