Barywani Salim Bary, Ergatoudes Constantinos, Schaufelberger Maria, Petzold Max, Fu Michael L X
Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Sahlgrenska University Hospital (SU)/Östra Hospital, Sweden.
Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Sahlgrenska University Hospital (SU)/Östra Hospital, Sweden.
Int J Cardiol. 2015;187:666-72. doi: 10.1016/j.ijcard.2015.03.428. Epub 2015 Apr 1.
In elderly patients with chronic heart failure (CHF), a gap exists between widespread use of lower doses of angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin-receptor blockers (ARBs) and β-blockers (BBs) and guideline recommendations. Therefore, the aim of the present study was to investigate whether patients receiving ≥ 50% target dose outperform those receiving <50% target dose, despite maximum up-titration, and whether the target dose outperforms all other doses.
Patients (n=185) aged ≥ 80 years with CHF and left ventricular ejection fraction ≤ 40% referred (between January 2000 and January 2008) to two CHF outpatient clinics at two university hospitals, were included and retrospectively studied. Of the study population, 53% received the target dose of ACEIs/ARBs, whereas 26% received <50% of the target dose. Half received <50% of the target dose of BBs and 21% received the target dose. After ≥ 5 years of follow-up, all-cause mortality was 76.8%. Patients who received the target dose of ACEIs/ARBs had higher survival rates from all-cause mortality than those receiving <50% of target dose (HR=0.6, 95%CI 0.4-0.9, P=0.033), but those receiving ≥ 50% of target dose did not statistically differ from those who achieved target dose. This dose-survival relationship was not the case for BBs.
Target dose of ACEIs/ARBs is associated with reduced all-cause five-year mortality in very old patients with systolic heart failure, despite that this was achievable in only about half of the patients. However, the clinical outcome of BB therapy is independent of BB dose when the target heart rate is achieved.
在老年慢性心力衰竭（CHF）患者中，低剂量血管紧张素转换酶抑制剂（ACEIs）/血管紧张素受体阻滞剂（ARBs）和β受体阻滞剂（BBs）的广泛使用与指南推荐之间存在差距。因此，本研究的目的是调查尽管进行了最大程度的剂量上调，但接受≥50%目标剂量的患者是否比接受<50%目标剂量的患者表现更好，以及目标剂量是否优于所有其他剂量。
纳入并回顾性研究了2000年1月至2008年1月间转诊至两家大学医院的两家CHF门诊的年龄≥80岁、CHF且左心室射血分数≤40%的患者（n = 185）。在研究人群中，53%接受了ACEIs/ARBs的目标剂量，而26%接受的剂量<目标剂量的50%。一半患者接受的BBs剂量<目标剂量的50%，21%接受了目标剂量。经过≥5年的随访，全因死亡率为76.8%。接受ACEIs/ARBs目标剂量的患者全因死亡率的生存率高于接受<50%目标剂量的患者（HR = 0.6，95%CI 0.4 - 0.9，P = 0.033），但接受≥50%目标剂量的患者与达到目标剂量的患者在统计学上无差异。BBs不存在这种剂量 - 生存关系。
ACEIs/ARBs的目标剂量与老年收缩性心力衰竭患者全因五年死亡率降低相关，尽管只有约一半的患者能够达到该剂量。然而，当达到目标心率时，BB治疗的临床结果与BB剂量无关。
