Department of Medicine, Columbia University Medical Center, College of Physicians and Surgeons, New York, New York 10032, USA.
J Card Fail. 2012 Aug;18(8):600-6. doi: 10.1016/j.cardfail.2012.06.526.
Fixed-dose combined isosorbide dinitrate/hydralazine (FDC I/H) significantly improved outcomes in patients with advanced heart failure (HF) receiving background neurohormonal therapy in the African-American Heart Failure Trial (A-HeFT). In this analysis, we investigated treatment effects by age <65 or ≥65 years.
Time-to-event curves were produced by the Kaplan-Meier method. Hazard ratios were calculated with the Cox proportional hazards model. Baseline characteristics showed that patients ≥65 years old had less hypertensive and more ischemic HF, better quality of life (QoL) scores, higher plasma B-type natriuretic peptide and creatinine levels, and received less background neurohormonal therapy. Kaplan-Meier curves showed that FDC I/H improved mortality and event-free survival in elderly patients. The hazard ratios for mortality, first heart failure hospitalization, and event-free survival (both unadjusted and adjusted for baseline differences), were similar quantitatively and in direction of effect in both age groups.
In A-HeFT, FDC I/H improved outcomes in HF patients aged <65 or ≥65 years, despite significant baseline differences between these age groups. Patients aged ≥65 years, a group at greater mortality risk, had the greatest survival benefit from FDC I/H.
固定剂量联合硝酸异山梨酯/肼屈嗪（FDC I/H）显著改善了接受神经激素背景治疗的晚期心力衰竭（HF）患者的结局，这在非洲裔美国人心力衰竭试验（A-HeFT）中得到了证实。在本分析中，我们按年龄<65 岁或≥65 岁对治疗效果进行了研究。
采用 Kaplan-Meier 方法生成时间事件曲线。采用 Cox 比例风险模型计算风险比。基线特征显示，年龄≥65 岁的患者高血压和缺血性 HF 较少，生活质量（QoL）评分较好，血浆 B 型利钠肽和肌酐水平较高，且接受的神经激素背景治疗较少。Kaplan-Meier 曲线显示，FDC I/H 改善了老年患者的死亡率和无事件生存率。死亡率、首次心力衰竭住院和无事件生存率（均未经调整和根据基线差异调整）的风险比在两个年龄组中在数量上和效果方向上相似。
在 A-HeFT 中，FDC I/H 改善了年龄<65 岁或≥65 岁的 HF 患者的结局，尽管这两个年龄组之间存在显著的基线差异。年龄≥65 岁的患者死亡风险较高，从 FDC I/H 中获益最大。
