Laboratoire de Biologie et Biométrie Evolutive-Equipe Modélisation des Effets Thérapeutiques, UMR 5558 Université Claude Bernard Lyon1, Rue Guillaume Paradin, Bp8071, 69376 Lyon Cedex 08, France.
BMC Cardiovasc Disord. 2013 Jul 13;13:52. doi: 10.1186/1471-2261-13-52.
In many studies, beta-blockers have been shown to decrease sudden cardiac death (SCD) in heart failure patients; other studies reported mixed results. Recently, several large randomized control trials of beta blockers have been carried out. It became necessary to conduct a systematic review to provide an up-to-date synthesis of available data.
We conducted a meta-analysis of all randomized controlled trials examining the use of beta-blockers vs. placebo/control for the prevention of SCD in heart failure patients. We identified 30 trials, which randomized 24,779 patients to beta-blocker or placebo/control. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Eligible studies had to be randomized controlled trials and provide information on the incidence of sudden cardiac death in heart failure patients. Additional inclusion criteria included: treatment for >30 days and follow-up≥3 months. Studies of patients<18 years, randomization to beta-blocker vs. an angiotensin converting enzyme (without placebo) and/or beta-blocker in both arms were excluded from the analysis. Pre-specified outcomes of interest included SCD, cardiovascular death (CVD), and all-cause mortality and were analyzed according to intention-to-treat.
We found that beta-blockers are effective in the prevention of SCD [OR 0.69; 95% CI, 0.62-0.77, P<0.00001], cardiovascular death (CVD) [OR 0.71; 95% CI, 0.64-0.79, P<0.00001], and all-cause mortality [OR 0.67; 95% CI, 0.59-0.76, P<0.00001]. Based on the study analysis, 43 patients must be treated with a beta-blocker to prevent one SCD, 26 patients to prevent one CVD and 21 patients to prevent all-cause mortality in one year.
Beta-blockers reduce the risk of sudden cardiac death (SCD) by 31%, cardiovascular death (CVD) by 29% and all-cause mortality by 33%. These results confirm the mortality benefits of these drugs and they should be recommended to all patients similar to those included in the trials.
在许多研究中，β受体阻滞剂已被证明可降低心力衰竭患者的心脏性猝死（SCD）；其他研究则报告了混合结果。最近，进行了几项β受体阻滞剂的大型随机对照试验。有必要进行系统评价，以提供现有数据的最新综合分析。
我们对所有检查β受体阻滞剂与安慰剂/对照用于预防心力衰竭患者 SCD 的随机对照试验进行了荟萃分析。我们确定了 30 项试验，共将 24779 名患者随机分为β受体阻滞剂或安慰剂/对照。遵循系统评价和荟萃分析的首选报告项目（PRISMA）指南。合格的研究必须是随机对照试验，并提供心力衰竭患者心脏性猝死发生率的信息。其他纳入标准包括：治疗>30 天且随访≥3 个月。我们排除了患者年龄<18 岁、随机分配至β受体阻滞剂与血管紧张素转换酶（无安慰剂）以及/或β受体阻滞剂在两个治疗组的研究，以及无法提供 SCD 数据的研究。预先规定的感兴趣的结局包括 SCD、心血管死亡（CVD）和全因死亡率，并根据意向治疗进行分析。
我们发现β受体阻滞剂可有效预防 SCD[OR 0.69；95%CI，0.62-0.77，P<0.00001]、心血管死亡（CVD）[OR 0.71；95%CI，0.64-0.79，P<0.00001]和全因死亡率[OR 0.67；95%CI，0.59-0.76，P<0.00001]。基于研究分析，需要治疗 43 例患者才能预防一例 SCD，26 例患者预防一例 CVD，21 例患者预防一年中的全因死亡率。
β受体阻滞剂可将心脏性猝死（SCD）的风险降低 31%，心血管死亡（CVD）的风险降低 29%，全因死亡率的风险降低 33%。这些结果证实了这些药物的生存获益，应向所有与试验患者相似的患者推荐这些药物。
