<International Circulation>:  What can be done to help reverse that trend?

   《国际循环》：需要采取什么措施才能逆转这种趋势？
　Prof Allen : I think we are still learning about that.  We know that re-admissions and hospitalizations are associated with high risk.  They are a marker that the disease has progressed but we do not have very good therapies to treat acute heart failure exacerbations.  We know that for stable patients with low ejection fractions that medications like beta blockers， ace inhibitors， aldosterone antagonists， and cardiac resynchronisation therapy can be very helpful in stabilizing this disease process and improving cardiac function.  However for patients with normal ejection fracture and for patients who are acutely decompensated studies have not shown those kinds of benefits.  So we do not have good data or good evidence based therapy for those patients. However， I think common sense can guide what to do for those patients.  We know that keeping their fluid status controlled helps to decrease symptoms and keep some of them out of the hospital.  We know that having good transitions of care from the hospitals to home， having good social support， is very important for these patients. And we know that treating all the other non-heart failure issues that are going on is incredibly important as well.  So they need their blood pressure well controlled， their diabetes well controlled， if they have ulcerations on their feet， if they are having nutritional issues， all those things common sense would tell us are going to make a difference and ultimately help stabilize the overall patients health and hopefully improve their outcomes.

    Dr Allen：我想我们一直都在努力解决这个问题。我们知道再入院和住院与高危风险相关。他们的病情已经恶化，但我们却没有好的措施来治疗急性心力衰竭。我们知道低射血分数且病情稳定的患者给予β-受体阻滞剂、ACE抑制剂、醛固酮拮抗剂、心脏再同步治疗可以很好地控制病情并改善心脏功能，但无研究证实射血分数正常和急性代偿失调的患者能受益于上述治疗措施。因此我们未能从这些患者的治疗中获得良好的数据或有力的证据，但我认为这些患者的治疗措施基本达到共识。我们知道控制患者的心脏体积理论上可以减少其症状和免住院。家庭和医院护理之间满意的转换，良好的社会支持对患者是极为重要的，我们也知道解决发生在他们身边的其它事情同样非常重要，因此需要有效地控制这些患者的血压、糖尿病。若他们出现足部溃疡，营养失调，所有的这些常识都提醒我们应改变治疗和护理措施以改善患者的预后和健康。

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