AHA《在社区层面上提高心血管健康》指南

美国心脏学会 (AHA)最近公布新文告 <社区心血管防治指南 >。它为社区的决策者、疾病防治部门、各种协会的志愿者以及有志于减少美国社区的心血管和脑卒中负荷的人们提供一个框架 ,其目的在提高基层社区心血管健康水平。指南的要点如下 :     

解读新膳食宝塔

2007年初,卫生部公布了《中国居民膳食指南（2007）》,新的膳食宝塔和1997年的相比较,有了新的调整,现就新的膳食宝塔进行解读,以便指导病友健康生活。     

学习《2005 AHA心肺复苏与心血管急救指南》的体会

《2005 AHA心肺复苏与心血管急救指南》(以下简称《指南》)全文发表在同年12月份的《循环》杂志[1]上,现浅谈学习心得如下.     

《中国心血管健康与疾病报告2021》要点解读

<正>随着社会经济的发展,国民生活方式的变化,尤其是人口老龄化及城镇化进程的加速,居民不健康生活方式日益突出,心血管病危险因素对居民健康的影响越加显著,心血管病的发病率仍持续增高。目前,中国心血管病死亡占城乡居民总死亡原因的首位,农村为46.74%,城市为44.26%,心血管病给居民和社会带来的经济负担日渐加重,已成为重大的公共卫生问题。为响应“健康中国行动”,贯彻“以基层为重点,以预防为主”的国家方针,     

《ADA／AHA／ACCF阿司匹林用于糖尿病人群心血管事件一级预防》指南解读（二）

ADA／AHA／ACCF指南对阿司匹林用于糖尿病患者心血管病一级预防的推荐如下： ①有理由在既往无心血管疾病史、且无出血危险性（根据既往胃肠道出血或消化道溃疡病史、或正在使用增加消化道出血风险的药物如NSAIDS或华法林）、心血管事件高危的糖尿病患者（10年心血管事件风险大于10％）,     

《2022年AHA/ACC/HFSA心力衰竭管理指南》解读——从新指南看治疗进展

<正>心力衰竭(简称“心衰”)是近年来发展最快的心血管亚专科之一,诊疗流程、药物及器械不断创新。2022年4月,美国心脏病学会/美国心脏协会/美国心衰学会(ACC/AHA/HFSA)在2013美国心衰管理指南^[1]和2017美国心衰管理指南更新^[2]的基础上,发布了2022年心衰管理指南^[3](简称“新指南”)。新指南强调以患者为中心,从心衰预防到诊治与管理,为临床医生提供重要参考。本文围绕心衰的治疗对新指南及其重要更新进行解读。     

《中国肺动脉高压诊断与治疗指南(2021版)》解读——指南撰写的方法学

近年来肺动脉高压(pulmonary hypertension,PH)领域取得了许多进展,诊断及治疗策略不断更新.来自国内外的专家也发表了 PH系列指南和专家共识.由于PH的诊断涉及多学科,容易造成误诊、漏诊,其治疗不规范也较普遍;为更好指导我国医师的临床实践,中华医学会呼吸病学分会肺栓塞与肺血管病学组、中国医师协会呼...     

《原发性骨质疏松症诊疗指南》解读

中华医学会骨质疏松和骨矿盐疾病学会按循证医学原则,制订了《原发性骨质疏松症诊疗指南》(简称《指南》),并将于近期公布。该《指南》分成概念、危险因素、临床表现、诊断和预防及治疗5部分,旨在帮助医生和患者对骨质疏松症防治作出最佳选择。《指南》制订时参考了其他的国家级指南,由于我国地域广大,卫生保健差异,《指南》应结合各地具体情况参照执行。     

《中国磁控胶囊胃镜临床应用指南（2021，上海）》解读

2021年12月《中国磁控胶囊胃镜临床应用指南（2021,上海）》正式发布,新指南对原有2017年版专家共识进行修订增补,根据标准原则规范流程制定,细化明确了磁控胶囊胃镜的定义范畴、临床适应证与禁忌证、检查过程与质控要点、局限与优化方向等内容。本文将对新指南的特点与重点内容进行简要说明与解读,以便医务人员更好地理解运用。     

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2011年11月8日,ACCF/AHA两大学会联合发表了肥厚型心肌病(HCM)诊断和治疗指南,这是国际几大学会首次针对这一疾病撰写指南,凸显了对肥厚型心肌病的重视,也体现了HCM近年来研究和发展及其迅速。指南分别从流行病学、临床定义、鉴别诊断、病程进展、病理生理学、诊断、疾病管理、其他问题和未来研究需要等各方面做了系统论述。     

ACC/AHA guidelines for preoperative cardiovascular evaluation for noncardiac surgery: a critical point of view

This review examines the issue of preoperative cardiac evaluation from a critical point of view, based on recent medical literature. We reviewed the history of that field and focused on the American College of Cardiology and American Heart Association guidelines, which are a cornerstone in the field of cardiac patients undergoing noncardiac surgery. These guidelines synthesized the data into a comprehensive format and established the concept of integrating the patient's risk with the surgical risk. Nevertheless, there are some weaknesses in the guidelines. We believe that a better understanding of the guideline limitations will allow an improved and more educated practice of its recommendations.     

新版指南解读：急性ST段抬高型心肌梗死的抗栓治疗

急性ST段抬高型心肌梗死（STEMI）是冠状动脉内血栓形成的急性心血管事件,无论是行急诊经皮冠状动脉介入还是药物溶栓,抗栓始终贯穿于治疗的全过程。由于近年来一些大规模随机临床试验结果的公布,欧洲心脏病学会（ESC）、美国心脏病学会基金会（ACCF）及美国心脏协会（AHA）相继公布了ST段抬高型心肌梗死的新版指南。指南指出：急性STEMI一旦确诊,应立即行抗血小板及抗凝治疗,抗血小板治疗为负荷量的阿司匹林（300 mg）及二磷酸腺苷（ADP）受体拮抗剂（氯吡格雷300～600 mg、普拉格雷60 mg、替格瑞洛180 mg）;ESC指南更倾向于使用替格瑞洛或普拉格雷;2个指南维持量的阿司匹林均倾向于小剂量（75～100 mg/d）。新指南对于低分子量肝素应用于急诊PCI的推荐力度有所下降,建议维持时间≤8 d。基于有效性和安全性的考虑,2个指南均建议在STEMI行急诊PCI时使用比伐芦定,尤其是对于伴有高出血风险的患者。     

Assessing the applicability of 2017 ACC/AHA hypertension guidelines for secondary stroke prevention in the BOSS study

Using data from the Blood Pressure and Clinical Outcome in TIA or Ischemic Stroke (BOSS) study, we aim to test the applicability and feasibility of stroke secondary prevention recommendations from the 2017 American College of Cardiology/American Heart Association guideline. Patients were categorized based on their blood pressure (BP) status at 3 months. The nonhypertension group was defined as those without a diagnosis of hypertension. The other patients were further divided into three subgroups according to office BP measured at 3‐month visit (BP <130/80, 130‐139/80‐89, and ≥140/90 mm Hg). The primary outcome was any stroke within one year. The associations between BP status and 1‐year prognosis (recurrent stroke, recurrent stroke/TIA, and poor functional outcome [modified Rankin scale score 3‐6]) were estimated. Among 2341 IS/TIA patients, additional 1056 patients were classified as uncontrolled hypertension at the 90‐day visit according to the new guidelines. Adjusted hazard/odds ratios (95% confidence intervals [CI]) for recurrent stroke in BP <130/80, 130‐139/80‐89, and ≥140/90 compared with nonhypertension group were 2.42 (95% CI: 0.87‐6.76), and 4.30 (95% CI: 1.73‐10.70), respectively. The prevalence of hypertension and uncontrolled BP among BOSS study population was substantially higher based on the new guidelines. BP of 130‐139/80‐89 did not show the worsened clinical outcomes compared with people without hypertension. Our study adds to the growing uncertainty about secondary prevention BP goal for IS/TIA patients.     

Quality assessment of clinical practice guidelines for eosinophilic esophagitis using the AGREE II instrument

Background: High-quality evidence-based clinical practice guidelines can guide diagnosis and treatment to optimize outcomes. We aimed to systematically review the quality of international guidelines on eosinophilic esophagitis (EoE).

Methods: MEDLINE and Scopus databases were searched for appropriate guidelines up to 2016. Two gastroenterologists and two methodologists independently evaluated the documents using the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument.

Results: Amongst the 25 records initially retrieved, four guidelines developed by recognized scientific organizations met inclusion criteria. AGREE II results varied widely across domains, but none achieved an overall assessment score of over 60%. Scope and purpose (61.82 ± 19.24%), clarity of presentation (57.13 ± 40.56%) and editorial independence (93.75 ± 1.69%) showed the highest mean rating, whereas stakeholder involvement (28.82 ± 11.19%), rigor of development (32.29 ± 12.02%) and applicability (21.62 ± 7.14%) did not reach quality thresholds. Intraclass correlation coefficients for agreement was excellent among appraisers (0.903), between gastroenterologists and methodologists (0.878) and for each individual guideline (0.838 to 0.955).

Conclusion: Clinical practice guidelines for EoE vary significantly in quality, are invariably limited and currently, none can be ‘strongly recommended’.     

Comparative efficacy of five long‐term weight loss drugs: quantitative information for medication guidelines

Quantitative information is scarce in current obesity medication guidelines, and they do not clearly reflect the differences in the efficacy characteristics among various drugs. This study quantitatively assessed the efficacy characteristics of five FDA‐approved long‐term weight loss drugs. Potentially eligible studies were obtained from public databases. Using the differences in the weight change from baseline between the drug group and the corresponding placebo group as the major indicator of efficacy, a time‐effect model was established, and crucial pharmacodynamic parameters, such as the maximal efficacy, drug onset time and rate of body weight regain after the maximal efficacy point, were used to reflect the differences in efficacy among the five drugs. Finally, 50 reports (involving 43,443 participants) were included. After deducting the placebo effects, the maximal efficacies (95% CI) of orlistat (120 mg), lorcaserin, naltrexone–bupropion, phentermine–topiramate (PT, 7.5/46 mg) and liraglutide were ?2.94 (?5.82, ?1.27), ?3.06 (?4.39, ?1.71), ?6.15 (?9.78, ?3.25), ?7.45 (?9.76, ?3.88) and ?5.50 (?10.62, ?2.97) kg at weeks 60, 54, 67, 59 and 65 respectively, and their rates of body weight regain were 0.51, 0.48, 0.91, 1.27and 0.43 kg per year respectively. The 1‐year dropout rates of orlistat, lorcaserin, naltrexone‐bupropion, PT and liraglutide were 29.0, 40.9, 49.1, 34.9 and 24.3% respectively. In addition, a significant dose–effect correlation was observed for orlistat and PT. This study provides valid quantitative information for medication guidelines.     

新型冠状病毒肺炎合并心血管外科急重症相关指南分析及经验总结

新型冠状病毒造成的严重急性呼吸道感染(COVID-19)是目前中国乃至全球的临床关注焦点.世界卫生组织及国家卫生健康委员会(卫健委)均发布了关于COVID-19诊疗的临时指南和管理策略建议.这些综合性指导意见为一线临床工作制定了基本规范.然而心血管外科疾病有其特殊病理生理特点,针对急危重症心血管疾病的外科治疗策略需要专门性指南.自2020年1月16日至2月12日,武汉协和医院心血管外科共完成心血管外科急诊手术13例,围术期成功率100%,基于临床实践体会,我们总结相关经验,并与世卫组织和国家卫健委指南进行对比,希望能与之互为补充,为抗击疫情一线的心血管外科医师治疗急重症患者提供参考.     

Application of the 2015 ACC/AHA/HRS guidelines for risk stratification for sudden death in adult patients with asymptomatic pre‐excitation

The management of the asymptomatic pre‐excited patient largely hinges on risk stratification and individual patient considerations and choice. A high threshold to treat patients may lead to a small overall risk of death while a low threshold clearly leads to increased invasive testing and ablation with associated cost and procedural risk. A firm recommendation to uniformly assess all by electrophysiology study or, alternatively, reassure all is inappropriate and unjustified by data as reflected in the recent guideline recommendations. The use of noninvasive and invasive parameters to identify the potentially at‐risk individual with surveillance for symptoms in those comfortable with this approach or ablation for those choosing this alternative for individual reasons remains the cornerstone of best practice.