Department of Cardiovascular Diseases, St Luke's-Roosevelt Hospital of the Mount Sinai Health System, New York, New York, USA.
Women's College Research Institute and Cardiovascular Division, Department of Medicine, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada.
Can J Cardiol. 2014 Aug;30(8):898-903. doi: 10.1016/j.cjca.2014.03.012. Epub 2014 Mar 15.
There is a concern about geographical region heterogeneity regarding clinical benefit of β-blocker (BB) therapy in heart failure with reduced ejection fraction (HFrEF). This study sought to compare benefits of BB use within randomized controlled trials (RCTs) that enrolled patients with HFrEF from North America (NA) compared with other regions of the world (ROW).
We conducted a meta-analysis using MEDLINE, EMBASE, Cochrane Library, Web of Science, and Scopus (inceptions-December 2012) of BB RCTs stratified according to NA vs ROW. The primary end point was all-cause mortality and secondary end points were cardiovascular death, sudden death, death due to pump failure, and premature drug discontinuation. Summary odds ratios (ORs) and 95% confidence intervals (CIs) for each outcome were calculated with interaction terms for region. Two-sided P values were calculated with P < 0.05 considered significant.
The analysis included 16 RCTs with 14,452 patients; 7 trials were conducted in NA and 9 trials in ROW with follow-up durations of 3-58 months. All-cause mortality was consistently reduced in NA (OR, 0.82; 95% CI, 0.71-0.96; P = 0.01) and ROW (OR, 0.76; 95% CI, 0.69-0.84; P < 0.001; P-interaction = 0.40). Overall and according to region, all secondary end points including premature drug discontinuation were also less with BB therapy (P-interactions all ≥ 0.10).
For the regions represented in the included trials, there is no evidence to suggest that geographic region is a significant moderator of clinical outcomes with BB therapy in HFrEF patients.
β受体阻滞剂（BB）治疗射血分数降低的心力衰竭（HFrEF）的临床获益存在地域差异。本研究旨在比较纳入 HFrEF 患者的随机对照试验（RCT）中 BB 使用的获益，这些 RCT 来自北美（NA）与世界其他地区（ROW）。
我们通过 MEDLINE、EMBASE、Cochrane 图书馆、Web of Science 和 Scopus（从起始日期至 2012 年 12 月）进行了一项荟萃分析，对 RCT 进行了分层，按 NA 与 ROW 进行分层。主要终点为全因死亡率，次要终点为心血管死亡、猝死、泵衰竭导致的死亡和提前停药。使用交互项对每个结局计算汇总比值比（OR）及其 95%置信区间（CI）。双侧 P 值计算，P < 0.05 认为有统计学意义。
该分析纳入了 16 项 RCT，共 14452 例患者；7 项试验在 NA 进行，9 项试验在 ROW 进行，随访时间为 3-58 个月。全因死亡率在 NA（OR，0.82；95%CI，0.71-0.96；P = 0.01）和 ROW（OR，0.76；95%CI，0.69-0.84；P < 0.001；P 交互作用= 0.40）中均显著降低。总体上以及按照地区，BB 治疗的所有次要终点，包括提前停药，也都减少（P 交互作用均≥0.10）。
在纳入研究的地区中，没有证据表明地理区域是 BB 治疗 HFrEF 患者临床结局的显著调节剂。
