Fonarow Gregg C, Abraham William T, Albert Nancy M, Stough Wendy Gattis, Gheorghiade Mihai, Greenberg Barry H, O'Connor Christopher M, Sun Jie Lena, Yancy Clyde, Young James B
Ahmanson-UCLA Cardiomyopathy Center, UCLA Medical Center, Los Angeles, CA 90095-1679, USA.
Am Heart J. 2007 Jan;153(1):82.e1-11. doi: 10.1016/j.ahj.2006.10.008.
The IMPACT-HF trial demonstrated that carvedilol use at the time of heart failure (HF) hospital discharge significantly increased 90-day postdischarge treatment rates. Whether there is an early survival benefit associated with this therapeutic approach in patients hospitalized for HF is unknown. We examined the early effects on mortality and rehospitalization of carvedilol use at discharge in patients hospitalized for HF and left ventricular systolic dysfunction (LVSD) compared with outcomes in patients who are eligible for, but do not receive, beta blockers before discharge.
The OPTIMIZE-HF program enrolled 5791 patients admitted with HF in a web-based registry at 91 hospitals participating with prespecified 60- to 90-day follow-up from March 2003 to December 2004. Outcomes data were prospectively collected on patients eligible for beta-blocker therapy and analyzed according to predischarge beta-blocker use.
The mean age was 69.7 years; 63% were male, etiology was ischemic in 52%, and mean left ventricular ejection fraction was 24.3%. A total of 2720 patients had LVSD, among whom 2373 (87.2%) were eligible to receive a beta blocker at discharge and carvedilol was prescribed in 1162 (49.0%). Discharge use of carvedilol was associated with a significant reduction in mortality risk at 60 to 90 days (hazard ratio 0.46, P = .0006) and mortality or rehospitalization (odds ratio 0.71, P = .0175) compared to no predischarge beta blocker. Predischarge use of carvedilol was well tolerated with high rates of continued therapy at 60 to 90 days follow-up. Similar findings were observed for other evidence-based beta blockers.
Carvedilol use at the time of HF hospital discharge is well tolerated, improves treatment rates, and is associated with an early survival benefit. These findings provide further support for guideline recommendations that carvedilol or other evidence-based beta blocker should be initiated before hospital discharge in stable patients with HF and LVSD.
IMPACT-HF试验表明，在心力衰竭（HF）出院时使用卡维地洛可显著提高出院后90天的治疗率。对于因HF住院的患者，这种治疗方法是否具有早期生存益处尚不清楚。我们研究了与出院前符合使用β受体阻滞剂条件但未接受该治疗的患者相比，HF合并左心室收缩功能障碍（LVSD）住院患者出院时使用卡维地洛对死亡率和再住院率的早期影响。
OPTIMIZE-HF项目在2003年3月至2004年12月期间，于91家医院的基于网络的登记系统中纳入了5791例因HF入院的患者，并进行了预先指定的60至90天随访。前瞻性收集符合β受体阻滞剂治疗条件患者的结局数据，并根据出院前β受体阻滞剂的使用情况进行分析。
平均年龄为69.7岁；63%为男性，52%的病因是缺血性的，平均左心室射血分数为24.3%。共有2720例患者存在LVSD，其中2373例（87.2%）在出院时符合接受β受体阻滞剂治疗的条件，1162例（49.0%）使用了卡维地洛。与出院前未使用β受体阻滞剂相比，出院时使用卡维地洛与60至90天的死亡风险显著降低（风险比0.46，P = 0.0006）以及死亡或再住院风险降低（优势比0.71，P = 0.0175）相关。出院前使用卡维地洛耐受性良好，在60至90天随访时继续治疗率较高。其他循证β受体阻滞剂也观察到类似结果。
HF出院时使用卡维地洛耐受性良好，可提高治疗率，并具有早期生存益处。这些发现为指南建议提供了进一步支持，即对于稳定的HF合并LVSD患者，应在出院前开始使用卡维地洛或其他循证β受体阻滞剂。
