循環器ジャーナル72巻1号

2024年01月発行

特集 在宅時代の心不全チーム医療—多職種連携，ACPから漢方まで Ⅱ.心不全の在宅医療

クリニック外来での心不全診療の実際—病院との連携をどうするか？

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.44 - P.52

POINT
●かかりつけ実地医家による早期心不全診断には，BNPまたはNT-proBNPの測定が有効である．
●循環器専門医は標準治療を導入し，外来診療はかかりつけ医との連携が重要である．
●急性心不全救急搬送基準の作成は，地域循環器専門施設との事前協議が必要である．

参考文献

1）Shimokawa H, Miura M, Nochioka K, et al. Heart failure as a general pandemic in Asia. Eur J Heart Fail 2015 ; 17 : 884-92.

2）McMurray JJ, Adamopoulos S, Anker SD, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012 : The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association（HFA）of the ESC. Eur Heart J 2012 ; 33 : 1787-847.

3）Zhang L, Ono Y, Qiao Q, et al. Trends in heart failure prevalence in Japan 2014-2019 : a report from healthcare administration databases. ESC Heart Fail 2023 ; 10 : 1996-2009.

4）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．2016　http://www.asas.or.jp/jhfs/pdf/Statement_HeartFailurel.pdf

5）Ponikowski P, Anker SD, AlHabib KF, et al. Heart failure : preventing disease and death worldwide. ESC Heart Fail 2014 ; 1 : 4-25.

6）Verhestraeten C, Weijers G, Debleu D, et al. Diagnosis, treatment, and follow-up of heart failure patients by general practitioners : A Delphi consensus statement. PLoS One 2020 ; 15 : e0244485.

7）Roalfe AK, Taylor CJ, Kelder JC, et al. Diagnosing heart failure in primary care : individual patient data meta-analysis of two European prospective studies. ESC Heart Fail 2021 ; 8 : 2193-201.

8）Tsuji K, Sakata Y, Nochioka K, et al. Characterization of heart failure patients with mid-range left ventricular ejection fraction-a report from the CHART-2 Study. Eur J Heart Fail 2017 ; 19 : 1258-69.

9）Jensen J, Poulsen MK, Petersen PW, et al. Prevalence of heart failure phenotypes and current use of therapies in primary care : results from a nationwide study. ESC Heart Fail 2023 ; 10 : 1745-56.

10）Liew D, Audehm RG, Haikerwal D, et al. Epidemiology of heart failure : Study of Heart failure in the Australian Primary carE setting（SHAPE）. ESC Heart Fail 2020 ; 7 : 3871-80.

11）Dai L, Dorje T, Gootjes J, et al. Primary care Adherence To Heart Failure guidelines IN Diagnosis, Evaluation and Routine management（PATHFINDER） : a randomised controlled trial protocol. BMJ Open 2023 ; 13 : e063656.

12）Komajda M, Anker SD, Cowie MR, 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 2016 ; 18 : 514-22.

13）Ponikowski P, Voors AA, Anker SD, 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 2016 ; 37 : 2129-200.

14）Nakane E, Kato T, Tanaka N, et al. Association of the induction of a self-care management system with 1-year outcomes in patients hospitalized for heart failure. J Cardiol 2021 ; 77 : 48-56.

15）Rich MW, Beckham V, Wittenberg C, et al. A multidisciplinary intervention to prevent the readmission of elderly patients with congestive heart failure. N Engl J Med 1995 ; 333 : 1190-5.

16）日本循環器学会（編）．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

17）Tsuchihashi-Makaya M, Matsuo H, Kakinoki S, et al. Home-based disease management program to improve psychological status in patients with heart failure in Japan. Circ J 2013 ; 77 : 926-33.

18）Raat W, Smeets M, Janssens S, et al. Impact of primary care involvement and setting on multidisciplinary heart failure management : a systematic review and meta-analysis. ESC Heart Fail 2021 ; 8 : 802-18.

19）Stewart S, Wiley JF, Ball J, 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 2016 ; 133 : 1867-77.

20）Whitty JA, Stewart S, Carrington MJ, 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 2013 ; 8 : e58347.