Blockers in Acute Decompensated Heart Failure wmshp受体阻滞剂在急性失代偿性心力衰竭 课件.ppt

Beta Blockers in Acute Decompensated Heart Failure Foranow GC. J Am Coll Cardiol 2008;52:190-9 The Hospitalized Patient In patients hospitalized with HF with reduced ejection fraction not treated with oral therapies known to improve outcomes, particularly ACE inhibitors or ARBs and beta-blocker therapy, initiation of these therapies is recommended in stable patients prior to hospital discharge. Initiation of beta-blocker therapy is recommended after optimization of volume status and successful discontinuation of intravenous diuretics, vasodilators, and inotropic agents. Beta-blocker therapy should be initiated at a low dose and only in stable patients. Particular caution should be used when initiating beta-blockers in patients who have required inotropes during their hospital course. New New In patients with evidence of severely symptomatic fluid overload in the absence of systemic hypotension, vasodilators such as intravenous nitroglycerin, nitroprusside or neseritide can be beneficial when added to diuretics and/or in those who do not respond to diuretics alone. The Hospitalized Patient Severe Symptomatic Fluid Overload New I IIa IIb III The Hospitalized Patient Comprehensive written discharge instructions for all patients with a hospitalization for HF and their caregivers is strongly recommended, with special emphasis on the following 6 aspects of care: diet, discharge medications, with a special focus on adherence, persistence, and uptitration to recommended doses of ACE inhibitor/ARB and beta-blocker medication, activity level, follow-up appointments, weight monitoring, and what to do if HF symptoms worsen. Reconciling and Adjusting Medications New Recommendations for Hospital Discharge /content/early/2013/06/03/CIR.0b013e31829e8776.citation Improvement of Guideline Beta-Blocker Prescribing in Heart Failure: A Cluster-Randomized Pragmatic Trial of a Pharmacy Intervention We conducted a pragmatic cluster-randomized trial, where facilities (n 5 12) with