2014年ESC指南發布：急性肺栓塞診治的新進展

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歐洲心臟病學會最新發布的2014年急性肺栓塞治療指南，強化並更新了臨床診斷、評估和治療的最佳做法。這份文件整合了新的臨床數據，包括簡化的臨床預測規則和新發現的靜脈血栓栓塞性疾病的易感因素，旨在提供更有效且客觀的治療策略，以應對疑似或確診的肺栓塞病患。

歐洲心臟病學會最新指南：改變心臟疾病治療的創新策略

2014 ESC Guidelines on the diagnosis and management of acute pulmonary embolism: The Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC)

Stavros V. Konstantinides, Adam Torbicki, Giancarlo Agnelli, Nicolas Danchin, David Fitzmaurice, Nazzareno Galiè, J. Simon R. Gibbs, Menno V. Huisman, Marc Humbert, Nils Kucher, Irene Lang, Mareike Lankeit, John Lekakis, Christoph Maack, Eckhard Mayer, Nicolas Meneveau, Arnaud Perrier, Piotr Pruszczyk, Lars H. Rasmussen, Thomas H. Schindler, Pavel Svitil, Anton Vonk Noordegraaf, Jose Luis Zamorano, Maurizio Zompatori, Jose Luis Zamorano, Stephan Achenbach, Helmut Baumgartner, Jeroen J. Bax, Hector Bueno, Veronica Dean, Christi Deaton, Çetin Erol, Robert Fagard, Roberto Ferrari, David Hasdai, Arno Hoes, Paulus Kirchhof, Juhani Knuuti, Philippe Kolh, Patrizio Lancellotti, Ales Linhart, Petros Nihoyannopoulos, Massimo F. Piepoli, Piotr Ponikowski, Per Anton Sirnes, Juan Luis Tamargo, Michal Tendera, Adam Torbicki, William Wijns, Stephan Windecker, Çetin Erol, David Jimenez, Walter Ageno, Stefan Agewall, Riccardo Asteggiano, Rupert Bauersachs, Cecilia Becattini, Henri Bounameaux, Harry R. Büller, Constantinos H. Davos, Christi Deaton, Geert-Jan Geersing, Miguel Angel Gómez Sanchez, Jeroen Hendriks, Arno Hoes, Mustafa Kilickap, Viacheslav Mareev, Manuel Monreal, Joao Morais, Petros Nihoyannopoulos, Bogdan A. Popescu, Olivier Sanchez, Alex C. Spyropoulos
Author Notes
European Heart Journal, Volume 35, Issue 43, 14 November 2014, Pages 3033–3080, https://doi.org/10.1093/eurheartj/ehu283
Published: 29 August 2014

https://academic.oup.com/eurheartj/article/35/43/3033/503581?login=false

Preamble

Guidelines summarize and evaluate all available evidence at the time of the writing process, on a particular issue with the aim of assisting health professionals in selecting the best management strategies for an individual patient, with a given condition, taking into account the impact on outcome, as well as the risk-benefit-ratio of particular diagnostic or therapeutic means. Guidelines and recommendations should help the health professionals to make decisions in their daily practice. However, the final decisions concerning an individual patient must be made by the responsible health professional(s) in consultation with the patient and caregiver as appropriate.

A great number of Guidelines have been issued in recent years by the European Society of Cardiology (ESC) as well as by other societies and organisations. Because of the impact on clinical practice, quality criteria for the development of guidelines have been established in order to make all decisions transparent to the user. The recommendations for formulating and issuing ESC Guidelines can be found on the ESC Web Site (http://www.escardio.org/guidelines-surveys/esc-guidelines/about/Pages/rules-writing.aspx). ESC Guidelines represent the official position of the ESC on a given topic and are regularly updated.

Members of this Task Force were selected by the ESC to represent professionals involved with the medical care of patients with this pathology. Selected experts in the field undertook a comprehensive review of the published evidence for management (including diagnosis, treatment, prevention and rehabilitation) of a given condition according to ESC Committee for Practice Guidelines (CPG) policy. A critical evaluation of diagnostic and therapeutic procedures was performed including assessment of the risk-benefit-ratio. Estimates of expected health outcomes for larger populations were included, where data exist. The level of evidence and the strength of recommendation of particular management options were weighed and graded according to predefined scales, as outlined in Tables 1 and 2

.

The experts of the writing and reviewing panels filled in declarations of interest forms which might be perceived as real or potential sources of conflicts of interest. These forms were compiled into one file and can be found on the ESC Web Site (http://www.escardio.org/guidelines). Any changes in declarations of interest that arise during the writing period must be notified to the ESC and updated. The Task Force received its entire financial support from the ESC without any involvement from healthcare industry.

The ESC CPG supervises and coordinates the preparation of new Guidelines produced by Task Forces, expert groups or consensus panels. The Committee is also responsible for the endorsement process of these Guidelines. The ESC Guidelines undergo extensive review by the CPG and external experts. After appropriate revisions it is approved by all the experts involved in the Task Force. The finalized document is approved by the CPG for publication in the European Heart Journal. It was developed after careful consideration of the scientific and medical knowledge and the evidence available at the time of their dating.

The task of developing ESC Guidelines covers not only the integration of the most recent research, but also the creation of educational tools and implementation programmes for the recommendations. To implement the guidelines, condensed pocket guidelines versions, summary slides, booklets with essential messages, summary cards for non-specialists, electronic version for digital applications (smartphones etc) are produced. These versions are abridged and, thus, if needed, one should always refer to the full text version which is freely available on the ESC Website. The National Societies of the ESC are encouraged to endorse, translate and implement the ESC Guidelines. Implementation programmes are needed because it has been shown that the outcome of disease may be favourably influenced by the thorough application of clinical recommendations.

Surveys and registries are needed to verify that real-life daily practice is in keeping with what is recommended in the guidelines, thus completing the loop between clinical research, writing of guidelines, disseminating them and implementing them into clinical practice.

Health professionals are encouraged to take the ESC Guidelines fully into account when exercising their clinical judgment as well as in the determination and the implementation of preventive, diagnostic or therapeutic medical strategies. However, the ESC Guidelines do not override in any way whatsoever the individual responsibility of health professionals to make appropriate and accurate decisions in consideration of each patient’s health condition and in consultation with that patient and the patient’s caregiver where appropriate and/or necessary. It is also the health professional’s responsibility to verify the rules and regulations applicable to drugs and devices at the time of prescription.

前言

指南在撰寫過程中總結和評估所有可用證據，針對特定問題，旨在協助衛生專業人員選擇最佳的管理策略，以適應患者個體情況，並考慮特定診斷或治療手段的結果影響以及風險-利益比 。 指南和建議應有助於衛生專業人員在日常實踐中做出決策。 但是，有關個別患者的最終決策必須由負有責任的衛生專業人員與患者和適當的護理人員協商確定。
近年來，歐洲心臟病學會（ESC）以及其他學會和組織發布了大量指南。 由於對臨床實踐的影響，已經建立了指南開發的品質標準，以使所有決策對使用者透明化。 有關製定和發布ESC指南的建議可以在ESC網站上找到（http://www.escardio.org/guidelines-surveys/esc-guidelines/about/Pages/rules-writing.aspx）。 ESC指南代表ESC在特定主題上的官方立場，並定期更新。

此工作小組的成員由ESC選定，代表與此病理學患者的醫療照護有關的專業人員。 該領域的專家進行了全面的管理（包括診斷、治療、預防和康復）的已發表證據的評估，根據ESC實踐指南委員會（CPG）政策。 對診斷和治療程序的風險-利益比進行了批判性評估。 如果存在數據，還包括更大人群的預期健康結果的估計。 根據預定的標度，根據預定的標度對特定管理選項的證據等級和建議強度進行了權衡和分級，如表1和表2所述。

專家小組的撰寫和審查小組成員填寫了可能被視為真實或潛在利益衝突來源的利益聲明表格。 這些表格已彙編成一個文件，可在ESC網站上找到（http://www.escardio.org/guidelines）。 在編寫期間出現的任何利益聲明變更都必須通知ESC並進行更新。 工作小組的全部財務支持均來自ESC，沒有任何來自醫療保健產業的參與。

ESC CPG監督和協調由工作小組、專家小組或共識小組制定的新指南的準備工作。 該委員會也負責對這些指南的認可過程。 ESC指南經過CPG和外部專家的廣泛審查。 經過適當修訂後，由工作小組中所有專家批准。 最終文件由CPG批准，以發表在《歐洲心臟雜誌》上。 它是在仔細考慮了科學和醫學知識以及其編寫時所提供的證據後製定的。

開發ESC指南的任務不僅涵蓋了最新研究的整合，還包括為建議制定教育工具和實施計劃。 為了實施指南，製作了精簡的口袋指南版本、摘要幻燈片、帶有基本資訊的小冊子、面向非專業人士的摘要卡片，以及數位應用程式（智慧型手機等）的電子版本。 這些版本都是簡化的，因此必要時應始終參考在ESC網站上免費提供的完整文字版本。 ESC鼓勵ESC各國協會支持、翻譯和實施ESC指南。 實施計劃是必要的，因為已經證明了透過徹底應用臨床建議可以有利地影響疾病的結果。

需要進行調查和註冊以驗證日常實踐是否與指南中建議的一致，從而完成了臨床研究、指南編寫、傳播和實施到臨床實踐之間的循環。

鼓勵衛生專業人員在行使其臨床判斷以及在確定和實施預防、診斷或治療醫療策略時充分考慮ESC指南。 但是，ESC指南絕不以任何方式取代衛生專業人員根據每位患者的健康狀況以及在適當和/或必要時與患者及患者護理人員協商做出適當和準確決策的個人責任。 衛生專業人員也有責任在處方時驗證適用於藥物和設備的規則和法規。