OCC-WCC 2024｜WCC-心衰论坛：全球地域差异显著，心衰诊疗应个体化

心衰是一种严重的临床综合征，其病理生理机制异常复杂，治疗策略多样且具有挑战性。随着全球人口老龄化趋势不断加剧，慢性疾病负担不断增加，心衰的管理和诊疗显得尤为紧迫。2024年6月29日，在第十八届东方心脏病学会议和世界心脏病学大会（OCC-WCC）的“心衰-基础与临床新资讯”单元，北京医院杨杰孚教授和英国伦敦大学Amitava Banerjee教授担任WCC-心衰论坛的联合主席，国内外专家学者共同分享了心衰领域的前沿动态，探讨心衰诊疗策略。

Heart failure is a serious clinical syndrome with extremely complex pathophysiological mechanisms and diverse and challenging treatment strategies. With the increasing trend of global population aging and the burden of chronic disease, the management and diagnosis of heart failure is particularly urgent. On June 29, 2024, at the " Heart Failure - Basic and Clinical Update" session of the 18th Oriental Cardiology Conference and World Congress of Cardiology (OCC- WCC), Professor Yang Jiefu of Beijing Hospital and Professor Amitava Banerjee of the University of London served as co-chairs of the WCC Heart Failure Forum. Experts and scholars from home and abroad shared cutting-edge developments in the field of heart failure and discussed strategies for the diagnosis and treatment of heart failure.

Fernando Lanas教授：

心衰存在地区差异，病因预后大不同

心衰的复杂性和多样性一直是研究的热点。智利拉弗朗特拉大学的Fernando Lanas教授从全球视角出发，重点阐述世界各地心衰的病因、诊断和治疗，为心衰的全球防治提供重要的前瞻性参考。他表示，心衰的病因和诊断在不同世界地区存在较大差异。目前中低收入国家的心衰患病率，也已呈现出明显的增长趋势。导致心衰的病因与社会环境相关，缺血性心脏病是导致中高收入国家和高收入国家人群心衰的重要致病原因，高达45%左右；而在中低收入和低收入国家，高血压是主要致病原因。心衰患者的预后也在很大程度上由所在国家/地区的收入水平决定，非洲和印度的心衰一年死亡率均高于全球平均水平，尤其是非洲，几近60%。心衰管理的复杂性和个体化需求至关重要，需根据地区特点制定有效的防治策略。

The complexity and diversity of heart failure have always been a focus of researchProfessor Femando Lanas of the University of La Frontera in Chile focused on thecauses, diagnosis and treatment of heat failure around the world from a globalperspective, providing an important forward-looking reference for the globalprevention and treatm ent of heart failure. He said that the causes and diagnosis of heartfailure vary greatly in different regions of the world At present, the prevalence of heartfailure in low- and middle-income countries has also shown a clear growth trend. Thecause of heart failure is related to the social environment. Ischemic heart disease is animportant cause of heart failure in people in middle- and high-income countries andhigh-income countries, with a rate of up to about 45 %: while in low- and middle-income and low-income countries, hypertension is the main cause. The prognosis ofpatients with heart failure is also largely determined by the income level of thecountry/region where they live. The one-year mortality rate of heart failure in Africaand India is higher than the global average, especially in Africa, which is nearly 60 %The complexity and individual needs of heart failure management are crucial, andeffective prevention and treatment strategies need to be formulated according toregional characteri stics.

John J.V. McMurray教授：

HFrEF最佳治疗方案的关键

英国格拉斯哥大学的John McMurray教授详尽描述了HFrEF的诊断和治疗策略，强调该疾病在医学领域的复杂性和难度，并以大量循证研究为例，探讨射血分数降低心力衰竭（HFrEF）患者的药物治疗策略。他表示，HFrEF最佳治疗方案关键在于迅速实施能够显著改善患者预后的药物治疗方案，同时需要根据患者的具体情况进行个性化治疗，确保药物容易使用且患者可耐受。John McMurray教授强调，尽快实施多种药物治疗对于HFrEF患者至关重要，因担心不良反应而放弃治疗，可能比不良反应本身更危险。因此，在治疗过程中必须密切监测患者的反应，并根据需要调整治疗方案，通过科学合理的药物治疗，可以显著提高HFrEF患者的生活质量和预后。

Professor John McMurray from the University of Glasgow, UK, described in detail the diagnosis and treatment strategies of HFrEF, emphasizing the complexity and difficulty of the disease in the medical field, and used a large number of evidence-based studies as examples to explore the treatment of patients with heart failure with reduced ejection fraction (HFrEF). Drug treatment strategies. He said that the key to the best treatment plan for HFrEF is to quickly implement a drug treatment plan that can significantly improve the patient's prognosis. At the same time, personalized treatment needs to be based on the patient's specific situation to ensure that the drug is easy to use and can be tolerated by the patient. Professor John McMurray emphasized that it is crucial for patients with HFrEF to implement multiple drug treatments as soon as possible. Giving up treatment because of concerns about adverse reactions may be more dangerous than the adverse reactions themselves. Therefore, the patient's response must be closely monitored during treatment and the treatment plan adjusted as needed. Through scientific and reasonable drug treatment, the quality of life and prognosis of HFrEF patients can be significantly improved.

Carolyn S.P. Lam教授：

心衰诊疗地域差异归因于医疗资源分配不均

新加坡国家心脏中心的Carolyn S.P. Lam教授在报告中具体阐述心衰患者的特征、结局和治疗的地理差异。整体而言，亚洲疾病负担日益加重，且地区间差异显著。这种差距与社会经济因素密切相关，医疗资源的分布不均以及卫生系统的薄弱更加剧了这一问题。比如在东南亚，心衰患者患病年龄普遍较年轻，但其临床结果却最差，这意味着在治疗方法和资源分配方面存在明显不足，亟待解决。特别值得关注的是，东南亚地区独特的瘦型糖尿病心衰表型为研究糖尿病和高血脂的作用机制提供了机会。理解这一表型的特征和机制，不仅有助于改善该地区的治疗效果，还可以为全球范围内的糖尿病和心衰治疗提供新的见解和方法。这些发现强调了加强区域间合作和资源共享的重要性，为更有效地应对日益加重的疾病负担提供帮助。

In her report, Professor Carolyn SP Lam from the National Heart Center of Singapore elaborated on the geographical differences in the characteristics, outcomes and treatment of heart failure patients. Overall, the disease burden in Asia is increasing, with significant regional differences. This disparity is closely related to socioeconomic factors, and is exacerbated by the uneven distribution of medical resources and the weakness of the health system. For example, in Southeast Asia, patients with heart failure are generally younger but have the worst clinical outcomes, which means there are obvious deficiencies in treatment methods and resource allocation that need to be addressed urgently. Of particular interest, the unique lean diabetic HF phenotype in Southeast Asia provides an opportunity to study the mechanisms of action of diabetes and hyperlipidemia. Understanding the characteristics and mechanisms of this phenotype will not only help improve treatment outcomes in this region, but also provide new insights and approaches to the treatment of diabetes and heart failure globally. These findings highlight the importance of strengthening interregional cooperation and resource sharing to help more effectively respond to the growing disease burden.

周京敏教授：

HFpEF诊疗难点要点解读

最后一位讲者是来自复旦大学附属中山医院周京敏教授，他重点介绍了《射血分数保留的心力衰竭诊断与治疗中国专家共识2023》，为中国乃至全球的HFpEF诊疗提供重要参考。射血分数保留心衰（HFpEF）是最常见的一种心衰，人群相对较大，但预后较差。近年来，HFpEF的发病机制、诊断与治疗取得较大进展，因此，中国专家参考国内外循证研究和相关指南，结合中国国情及临床实践制定该共识。共识强调对病因与合并症进行针对性管理，以改善症状和预后，并对HFpEF规范治疗和长期管理给出指导建议。建议在HFpEF诊断后，首先根据病因分型处理原则进行干预。在此基础上，再尽早联合使用推荐的药物，并定期随访评估LVEF，强调HFpEF患者长期管理，包括危险因素与合并症管理、持续GDMT、运动康复、加强患者教育、提高治疗依从性等。

The last speaker was Professor Zhou Jingmin from Zhongshan Hospital Affiliated to Fudan University. He focused on the " 2023 Chinese Expert Consensus on diagnosis and treatment of HFpEF", which provides an important reference for the diagnosis and treatment of HFpEF in China and even the world. Heart failure with preserved ejection fraction (HFpEF) is the most common type of heart failure, with a relatively large population, but a poor prognosis. In recent years, great progress has been made in the pathogenesis, diagnosis and treatment of HFpEF. Therefore, Chinese experts have formulated this consensus based on evidence-based research and relevant guidelines at home and abroad, combined with China's national conditions and clinical practice. The consensus emphasizes targeted management of etiology and comorbidities to improve symptoms and prognosis, and provides guidance and suggestions for standardized treatment and long-term management of HFpEF. It is recommended that after the diagnosis of HFpEF, intervention should be carried out first according to the principle of etiology classification. On this basis, the recommended drugs should be used in combination as soon as possible, and regular follow-up should be performed to assess LVEF, emphasizing the long-term management of HFpEF patients, including risk factor and comorbidity management, continuous GDMT, exercise rehabilitation, strengthening patient education, and improving treatment compliance.

随着全球老龄化的加剧和生活方式的改变，心衰已经成为全球公共卫生的重大挑战。在不同地域之间，心衰的流行病学存在显著差异，这些地域差异与遗传、环境、社会、生活方式等多种因素相关。因此，对于心衰的预防和治疗，需要考虑到地域差异，了解其发病规律、危险因素和预防策略，对于降低心衰的发病率和死亡率，改善患者的生活质量具有重要的意义。

With the intensification of global aging and changes in lifestyles, heart failure has become a major challenge to global public health. There are significant differences in the epidemiology of heart failure between different regions, and these regional differences are related to multiple factors such as genetics, environment, society, and lifestyle. Therefore, for the prevention and treatment of heart failure, it is necessary to take into account regional differences and understand its incidence patterns, risk factors and prevention strategies, which is of great significance for reducing the morbidity and mortality of heart failure and improving the quality of life of patients.

审核：杨杰孚

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