监测
患者从专业中心的定期专业评估或心力衰竭管理项目的定期监测中获益。[2]Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013 Oct 15;62(16):e147-239.
http://www.onlinejacc.org/content/62/16/e147
http://www.ncbi.nlm.nih.gov/pubmed/23747642?tool=bestpractice.com
每次就诊应评估患者的日常生活能力和预期活动能力，还需评估患者的容量状态和体重。每次就诊应仔细询问并记录患者的病史，包括饮酒、吸烟、吸毒、使用非传统疗法和化疗药物、以及饮食和钠摄入。对心力衰竭患者有临床状况变化、或者曾发生或从一个临床事件中恢复、或曾接受可能会明显改善心功能的治疗的患者，重复测量射血分数并评估心脏重构的严重程度可提供有用的信息。对于通过脑钠肽的系列检测来指导患者治疗的价值目前仍未确定。数据显示，利用利钠肽指导治疗可降低由心力衰竭所致住院率，并且可为年龄小于 75 岁的患者提供生存获益。[238]Troughton RW, Frampton CM, Brunner-La Rocca HP, et al. Effect of B-type natriuretic peptide-guided treatment of chronic heart failure on total mortality and hospitalization: an individual patient meta-analysis. Eur Heart J. 2014 Jun 14;35(23):1559-67.
https://academic.oup.com/eurheartj/article/35/23/1559/459004
http://www.ncbi.nlm.nih.gov/pubmed/24603309?tool=bestpractice.com
然而，一项随机试验发现，在心力衰竭高风险患者中，利钠肽指导治疗在结局改善方面并不优于单纯最佳药物治疗。[239]Felker GM, Anstrom KJ, Adams KF, et al. Effect of natriuretic peptide-guided therapy on hospitalization or cardiovascular mortality in high-risk patients with heart failure and reduced ejection fraction: a randomized clinical trial. JAMA. 2017 Aug 22;318(8):713-20.
https://jamanetwork.com/journals/jama/fullarticle/2649188
http://www.ncbi.nlm.nih.gov/pubmed/28829876?tool=bestpractice.com
使用远程设备来监控患者是一个新兴治疗领域，但需要进一步评估。[240]Chaudhry SI, Phillips CO, Stewart SS, et al. Telemonitoring for patients with chronic heart failure: a systematic review. J Card Fail. 2007 Feb;13(1):56-62.
http://www.ncbi.nlm.nih.gov/pubmed/17339004?tool=bestpractice.com
[241]Clark RA, Inglis SC, McAlister FA, et al. Telemonitoring or structured telephone support programmes for patients with chronic heart failure: systematic review and meta-analysis. BMJ. 2007 May 5;334(7600):942.
https://www.bmj.com/content/334/7600/942.long
http://www.ncbi.nlm.nih.gov/pubmed/17426062?tool=bestpractice.com
[242]Inglis SC, Clark RA, McAlister FA, et al. Which components of heart failure programmes are effective? A systematic review and meta-analysis of the outcomes of structured telephone support or telemonitoring as the primary component of chronic heart failure management in 8323 patients: abridged Cochrane review. Eur J Heart Fail. 2011 Sep;13(9):1028-40.
https://onlinelibrary.wiley.com/doi/full/10.1093/eurjhf/hfr039
http://www.ncbi.nlm.nih.gov/pubmed/21733889?tool=bestpractice.com
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What are the benefits and harms of structured telephone support or non-invasive telemonitoring in patients with heart failure?/cca.html?targetUrl=https://cochranelibrary.com/cca/doi/10.1002/cca.1059/full展示答案
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In people with heart failure, what are the effects of interactive telemedicine?/cca.html?targetUrl=https://cochranelibrary.com/cca/doi/10.1002/cca.1311/full展示答案
用于治疗慢性心力衰竭患者的无线肺血液动力学监测可大幅降低心力衰竭住院率。[243]Abraham WT, Adamson PB, Bourge RC, et al. Wireless pulmonary artery haemodynamic monitoring in chronic heart failure: a randomised controlled trial. Lancet. 2011 Feb 19;377(9766):658-66. http://www.ncbi.nlm.nih.gov/pubmed/21315441?tool=bestpractice.com
结构化电话支持和非侵入性家庭远程监控可降低死亡率并减少心力衰竭相关性住院治疗。[244]Inglis SC, Clark RA, Dierckx R, et al. Structured telephone support or non-invasive telemonitoring for patients with heart failure. Cochrane Database Syst Rev. 2015 Oct 31;(10):CD007228. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007228.pub3/full http://www.ncbi.nlm.nih.gov/pubmed/26517969?tool=bestpractice.com
然而，有创性血流动力学监测在临床实践中并不常规使用，但可能适用于个体患者，尤其是那些复发性心力衰竭的患者。
在一项针对 NYHA III 级心力衰竭患者的研究中，与对照组相比，使用无线植入式血流动力学监测显著减少了心力衰竭相关性住院治疗。[243]Abraham WT, Adamson PB, Bourge RC, et al. Wireless pulmonary artery haemodynamic monitoring in chronic heart failure: a randomised controlled trial. Lancet. 2011 Feb 19;377(9766):658-66. http://www.ncbi.nlm.nih.gov/pubmed/21315441?tool=bestpractice.com
运动训练和康复
对于心力衰竭患者，心脏康复和运动训练可提高运动耐量和生活质量，同时降低发病率和死亡率。[245]Ades PA, Keteyian SJ, Balady GJ, et al. Cardiac rehabilitation exercise and self-care for chronic heart failure. JACC Heart Fail. 2013 Dec;1(6):540-7. http://heartfailure.onlinejacc.org/content/1/6/540 http://www.ncbi.nlm.nih.gov/pubmed/24622007?tool=bestpractice.com [
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What are the effects of exercise‐based cardiac rehabilitation for adults with heart failure?/cca.html?targetUrl=https://www.cochranelibrary.com/cca/doi/10.1002/cca.2436/full展示答案 因此鼓励心力衰竭稳定的患者进行常规的有氧运动，并建议他们参加多学科治疗管理计划。[1]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). Eur J Heart Fail. 2016 Aug;18(8):891-975.
https://onlinelibrary.wiley.com/doi/full/10.1002/ejhf.592
http://www.ncbi.nlm.nih.gov/pubmed/27207191?tool=bestpractice.com
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What are the benefits and harms of disease management interventions for adults with heart failure?/cca.html?targetUrl=https://www.cochranelibrary.com/cca/doi/10.1002/cca.2462/full展示答案 一份共识文件详细介绍了心力衰竭运动训练。[246]Piepoli MF, Conraads V, Corrà U, et al. Exercise training in heart failure: from theory to practice. A consensus document of the Heart Failure Association and the European Association for Cardiovascular Prevention and Rehabilitation. Eur J Heart Fail. 2011 Apr;13(4):347-57.
https://onlinelibrary.wiley.com/doi/full/10.1093/eurjhf/hfr017
http://www.ncbi.nlm.nih.gov/pubmed/21436360?tool=bestpractice.com
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