Service de Pharmacologie Clinique, AP-HP, Hôpital H. Mondor-A. Chenevier, Créteil 94000, France.
Eur J Clin Pharmacol. 2013 Apr;69(4):901-8. doi: 10.1007/s00228-012-1400-9. Epub 2012 Sep 21.
We previously reported that chronic heart failure (CHF) treatments reduce the duration of hospitalisation, even in elderly patients. The present study aimed to determine whether CHF treatment also provides long-term benefits in terms of reduced mortality at 8 years.
A cohort of 281 patients who were admitted to a French teaching hospital with a main diagnosis of CHF were followed through the health insurance databases for 1 year and through the national mortality database for 8 years.
Diuretics (236 patients, 84 %) and angiotensin-converting enzyme (ACE) inhibitors (193 patients, 69 %) were the most-frequently prescribed medications. The median duration of survival was 46 months. Mortality rates were significantly lower for patients administered beta-blockers (59 %) and statins (56 %) than for patients not exposed to these drugs (82 %, p < 0.001 and 78 %, p = 0.001 respectively). No significant differences in mortality were observed for spironolactone, diuretics or ACE inhibitors. After adjustment, beta-blocker treatment remained associated with a significantly lower risk of mortality (hazard ratio, HR = 0.54 [0.34-0.84]). After adjustment, the use of two or three CHF drugs was associated with longer survival (HR = 0.53 [0.36-0.77]) than the use of zero or one CHF drug. Statins were also associated with longer survival after adjustment (HR = 0.53 [0.31-0.89]). In patients 75 years of age or older (n = 73), only beta-blocker treatment was associated with a significantly lower risk of mortality (HR = 0.31 [0.16-0.63]) in multivariate analysis.
The use of beta-blockers was associated with better survival rates. The use of statins was also associated with better survival at 8 years. Randomised controlled trials are required to confirm these observations.
我们之前报道过，慢性心力衰竭（CHF）的治疗可减少住院时间，即使是老年患者。本研究旨在确定 CHF 治疗是否也能在 8 年内降低死亡率方面带来长期获益。
我们对 281 名因 CHF 主要诊断而被收入法国教学医院的患者进行了队列研究，通过医疗保险数据库随访了 1 年，并通过国家死亡率数据库随访了 8 年。
利尿剂（236 例，84%）和血管紧张素转换酶（ACE）抑制剂（193 例，69%）是最常开的药物。中位生存时间为 46 个月。与未使用这些药物的患者（82%，p<0.001 和 78%，p=0.001）相比，使用β受体阻滞剂（59%）和他汀类药物（56%）的患者死亡率显著更低。螺内酯、利尿剂或 ACE 抑制剂的死亡率无显著差异。调整后，β受体阻滞剂治疗仍与较低的死亡风险显著相关（风险比，HR=0.54 [0.34-0.84]）。调整后，使用两种或三种 CHF 药物与更长的生存时间相关（HR=0.53 [0.36-0.77]），而使用零种或一种 CHF 药物与更短的生存时间相关。调整后他汀类药物也与更长的生存时间相关（HR=0.53 [0.31-0.89]）。在 75 岁及以上的患者（n=73）中，仅在多变量分析中β受体阻滞剂治疗与较低的死亡风险显著相关（HR=0.31 [0.16-0.63]）。
β受体阻滞剂的使用与更高的生存率相关。他汀类药物的使用也与 8 年后的生存相关。需要进行随机对照试验来证实这些观察结果。
