Fowler Michael B, Lottes Sandra R, Nelson Jeanenne J, Lukas Mary Ann, Gilbert Edward M, Greenberg Barry, Massie Barry M, Abraham William T, Franciosa Joseph A
Division of Cardiovascular Medicine, Stanford University Medical Center, Palo Alto, CA, USA.
Am Heart J. 2007 Jun;153(6):1029-36. doi: 10.1016/j.ahj.2007.03.010.
Community patients with heart failure (HF) are older, less often treated by HF specialists, and have more comorbidity than those in randomized clinical trials. These differences might affect beta-blocker prescribing in HF.
To explore patterns of beta-blocker prescribing for HF in the community and their association with outcomes, we determined carvedilol doses at end titration in 4113 patients from a community-based beta-blocker HF registry according to physician and patient characteristics, HF severity, and rates of hospitalization and death.
Female sex, age > or = 65 years, and left ventricular ejection fraction > or = 35% were associated with lower beta-blocker doses. Average daily dose of beta-blocker was lower with worse baseline New York Heart Association class. More patients of cardiologists achieved carvedilol doses > or = 25 mg twice daily, whereas in those of noncardiologists lower doses were more common. Relative risk of HF hospitalizations or all-cause death was significantly lower with higher doses of beta-blocker.
Beta-blocker dosing in community HF appears lower than in randomized clinical trials, especially when prescribed by noncardiologists. At all doses, patients taking the beta-blocker carvedilol have a lower incidence of death and HF hospitalization than those discontinuing it, regardless of physician type in the community setting.
与随机临床试验中的患者相比，社区心力衰竭（HF）患者年龄更大，接受HF专科医生治疗的频率更低，合并症更多。这些差异可能会影响HF患者β受体阻滞剂的处方。
为了探究社区中HF患者β受体阻滞剂的处方模式及其与预后的关系，我们根据医生和患者特征、HF严重程度以及住院率和死亡率，确定了来自社区β受体阻滞剂HF登记处的4113例患者在滴定结束时的卡维地洛剂量。
女性、年龄≥65岁以及左心室射血分数≥35%与较低的β受体阻滞剂剂量相关。纽约心脏协会基线分级越差，β受体阻滞剂的平均日剂量越低。心脏病专家治疗的患者中，更多患者达到了卡维地洛剂量≥25mg每日两次，而非心脏病专家治疗的患者中，较低剂量更为常见。β受体阻滞剂剂量越高，HF住院或全因死亡的相对风险显著降低。
社区HF患者的β受体阻滞剂剂量似乎低于随机临床试验中的剂量，尤其是非心脏病专家开具处方时。在社区环境中，无论医生类型如何，服用β受体阻滞剂卡维地洛的患者的死亡和HF住院发生率均低于停药患者。
