論文

国際誌
2021年2月

Appropriateness rating for the application of optimal medical therapy and multidisciplinary care among heart failure patients.

ESC heart failure
  • Satoshi Shoji
  • ,
  • Shun Kohsaka
  • ,
  • Yasuyuki Shiraishi
  • ,
  • Shogo Oishi
  • ,
  • Mahoto Kato
  • ,
  • Shigehito Shiota
  • ,
  • Yasuko Takada
  • ,
  • Atsushi Mizuno
  • ,
  • Dai Yumino
  • ,
  • Hiroyuki Yokoyama
  • ,
  • Noboru Watanabe
  • ,
  • Mitsuaki Isobe

8
1
開始ページ
300
終了ページ
308
記述言語
英語
掲載種別
研究論文(学術雑誌)
DOI
10.1002/ehf2.13062

AIMS: Clinical guidelines for improving the patients' quality of care vary in clinical practice, particularly in super-aging societies, like in Japan. We aimed to develop a set of appropriate-use criteria (AUC) for contemporary heart failure (HF) management to assist physicians in decision making. METHODS AND RESULTS: With the use of the RAND methodology, a multidisciplinary writing group developed patient-based clinical scenarios in 10 selected key topics, stratified mainly by HF stage, age, and renal function. Nine nationally recognized expert panellists independently rated the clinical scenario appropriateness twice on a scale of 1-9, as 'appropriate' (7-9), 'may be appropriate' (4-6), or 'rarely appropriate' (1-3). Decisions were based on clinical evidence and professional opinions in the context of available resource use and costs. An interactive round-table discussion was held between the first and second ratings; the median score of the nine experts was then assigned to an appropriate-use category. Most clinical scenarios without strong evidence were evaluated as 'may be appropriate'. Frailty assessments in elderly patients (age ≥ 75 years), regardless of the HF stage, and advanced care planning in patients with stage C/D HF, regardless of age, were considered 'appropriate'. For HF with reduced ejection fraction, beta-blocker administration in elderly patients (age ≥ 75 years) with heart rate < 50 b.p.m. and mineral corticosteroid receptor antagonist use in elderly patients (age ≥ 75 years) with an estimated glomerular filtration rate < 30 mL/min/1.73 m2 were considered 'rarely appropriate'. CONCLUSIONS: The HF management AUC provide a practical guide for physicians regarding scenarios commonly encountered in daily practice.

リンク情報
DOI
https://doi.org/10.1002/ehf2.13062
PubMed
https://www.ncbi.nlm.nih.gov/pubmed/33201597
PubMed Central
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7835502
ID情報
  • DOI : 10.1002/ehf2.13062
  • PubMed ID : 33201597
  • PubMed Central 記事ID : PMC7835502

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