Ural Dilek, Kandemir Aysen Şimşek, Karaüzüm Kurtuluş, Baydemir Canan, Karaüzüm İrem Yılmaz, Bozyel Serdar, Kozdağ Güliz, Ağır Ayşen Ağaçdiken
Koç University, School of Medicine, Department of Cardiology, Istanbul, Turkey.
Kocaeli University, Hereke Vocational School, Department of Biostatistics, Kocaeli, Turkey.
J Card Fail. 2017 Apr;23(4):286-292. doi: 10.1016/j.cardfail.2017.02.006. Epub 2017 Feb 21.
Hydralazine-nitrate combination is recommended for patients with heart failure with reduced ejection fraction (HFrEF)/systolic heart failure who are symptomatic despite guideline-directed medical therapy (GDMT). Use of nitrates alone for this indication is not well-established. This study aims to evaluate the effect of oral nitrates on all-cause mortality and hospitalization in HFrEF patients using GDMT.
Nitrate prescription at discharge and its association with all-cause mortality and heart failure hospitalization were examined in a propensity-matched analysis of 648 HFrEF patients followed for a median of 56 months. A total of 269 (42%) patients died during that period. In Cox regression analysis, nitrate usage was associated with a slightly increased mortality risk compared with not using nitrates (hazard ratio 1.29; 95% confidence interval 1.01-1.65; P = .040), which continued modestly after the propensity-matched analysis (hazard ratio 1.26; 95% confidence interval 0.95-1.68; P = .102). In both prematch and propensity-matched analyses, nitrate use was not associated with risk of rehospitalization. No significant effect was detected on subgroups stratified by coronary artery disease, age, gender, and background medical therapy.
In this study, oral nitrate use alone in addition to GDMT did not affect all-cause mortality and hospitalization risk in HFrEF patients during a long-term follow-up. There was even a modest tendency for increased risk of mortality.
对于射血分数降低的心力衰竭（HFrEF）/收缩性心力衰竭患者，尽管接受了指南指导的药物治疗（GDMT）但仍有症状，推荐使用肼屈嗪 - 硝酸盐联合治疗。单独使用硝酸盐治疗该适应症的效果尚未明确。本研究旨在评估口服硝酸盐对使用GDMT的HFrEF患者全因死亡率和住院率的影响。
在对648例HFrEF患者进行的倾向匹配分析中，研究了出院时的硝酸盐处方及其与全因死亡率和心力衰竭住院率的关系，这些患者的中位随访时间为56个月。在此期间共有269例（42%）患者死亡。在Cox回归分析中，与未使用硝酸盐相比，使用硝酸盐与死亡风险略有增加相关（风险比1.29；95%置信区间1.01 - 1.65；P = 0.040），在倾向匹配分析后这种情况仍略有存在（风险比1.26；95%置信区间0.95 - 1.68；P = 0.102）。在匹配前和倾向匹配分析中，使用硝酸盐均与再住院风险无关。在按冠状动脉疾病、年龄、性别和背景药物治疗分层的亚组中未检测到显著影响。
在本研究中，除GDMT外单独使用口服硝酸盐在长期随访期间并未影响HFrEF患者的全因死亡率和住院风险。甚至有死亡率风险略有增加的趋势。
