Desai Vibha C A, Kelton Christina M L, Metzger Anne H, Cavanaugh Teresa M, Guo Jeff J, Heaton Pamela C
University of Cincinnati Academic Health Center, Cincinnati, OH, USA.
University of Cincinnati, Cincinnati, OH, USA
Ann Pharmacother. 2014 Dec;48(12):1570-9. doi: 10.1177/1060028014552819. Epub 2014 Oct 3.
For patients with atrial fibrillation (AF), early treatment is essential to prevent serious complications such as stroke. Several randomized clinical trials have shown that rate-control may be as effective as rhythm-control medications, whereas the latter have serious side effects. Little evidence exists, however, about which class of rate-control medication-β-blockers (BBs) or calcium channel blockers (CCBs)-may be superior.
The objective was to compare the long-term persistence on BBs versus CCBs in nonelderly adult patients with AF.
A longitudinal retrospective cohort study for patients 40 to 60 years old with newly diagnosed AF (identified by ICD-9 code 427.31) was performed using data from Ohio Medicaid physician, institutional, and pharmacy claims from January 2006 through June 2011. A Cox proportional hazard regression, with time to change out of rate-control therapy as the dependent variable, was estimated to compare persistence on (proxy for effectiveness of) rate-control medication across drug classes. A propensity-score analysis was used to control for selection bias. Additional covariates included age, development of heart failure, and medication adherence.
Out of 1239 patients included in the cohort, 1016 received a BB; 223 received a CCB. Over time, patients on CCBs were significantly more likely to switch out of rate-control therapy (hazard ratio = 1.89; 95% CI = 1.14-3.09) than patients on BBs.
Evidence suggests that nonelderly AF patients, when prescribed rate-control therapy, persist longer on BBs than CCBs. Because this is the first long-term study comparing the 2 drug classes in the nonelderly population, further research is suggested.
对于心房颤动（AF）患者，早期治疗对于预防中风等严重并发症至关重要。多项随机临床试验表明，心率控制可能与节律控制药物同样有效，而后者具有严重的副作用。然而，关于哪类心率控制药物——β受体阻滞剂（BBs）或钙通道阻滞剂（CCBs）——可能更具优势，几乎没有证据。
目的是比较非老年AF成年患者使用BBs与CCBs的长期持续性。
使用2006年1月至2011年6月俄亥俄州医疗补助计划中医生、机构和药房报销数据，对40至60岁新诊断为AF（由ICD-9代码427.31识别）的患者进行纵向回顾性队列研究。以停止心率控制治疗的时间为因变量，估计Cox比例风险回归，以比较不同药物类别心率控制药物的持续性（作为有效性的替代指标）。采用倾向得分分析来控制选择偏倚。其他协变量包括年龄、心力衰竭的发展和药物依从性。
队列中的1239名患者中，1016名接受了BBs治疗；223名接受了CCBs治疗。随着时间的推移，与接受BBs治疗的患者相比，接受CCBs治疗的患者更有可能停止心率控制治疗（风险比=1.89；95%置信区间=1.14-3.09）。
有证据表明，非老年AF患者在接受心率控制治疗时，使用BBs的持续时间比CCBs更长。由于这是第一项比较非老年人群中这两类药物的长期研究，建议进行进一步研究。
