Department of Cardiology, Herlev-Gentofte University Hospitals, Copenhagen, Denmark.
National Institute of Public Health, Copenhagen, Denmark.
Europace. 2018 Feb 1;20(2):301-307. doi: 10.1093/europace/euw408.
We aimed to examine the use of guideline recommended beta-blocker therapy prior to and after primary prevention implantable cardioverter defibrillator (ICD) implantation in a 'real-life' setting.
From the Danish Pacemaker and ICD Registry we identified all 1st-time primary prevention ICD and cardiac resynchronization therapy defibrillator (CRT-D) implantations in Denmark from 2007-12 (n = 2935). Use of beta-blocker, type and dose was acquired through the Danish Prescription Registry. According to guideline recommendations, we defined target daily doses as ≥50 mg carvedilol and ≥200 mg metoprolol. Prior to implantation 2427 of 2935 (83%) patients received beta-blocker therapy, with 2166 patients (89%) having initiated treatment 3 months or more prior to implantation. The majority of patients was prescribed carvedilol (52%) or metoprolol (41%). Patients on carvedilol reached target dosages more frequently than patients on metoprolol, with 39% of patients on carvedilol and 26% of patients on metoprolol at the time of implantation (P < 0.001 for all time-points). Increase in proportion of patients reaching target daily doses was observed for both carvedilol and metoprolol after ICD implantation. Carvedilol treatment was a strong predictor for being on target dose of BB at time of implant, as was treatment with angiotensin-converting enzyme inhibitors and/or spironolactone, no history of myocardial infarction, younger age and less pronounced heart failure symptoms.
In a real-life setting of primary prevention ICD patients, 39% and 26% of patients were titrated to optimal target dose of carvedilol or metoprolol prior to implantation. A higher proportion of patients on carvedilol reached target dose, as compared with metoprolol.
我们旨在检查在丹麦真实环境下，植入式心脏复律除颤器（ICD）一级预防应用指南推荐的β受体阻滞剂治疗的使用情况，包括植入前和植入后。
我们从丹麦起搏器和 ICD 注册中心确定了 2007 年至 2012 年期间丹麦首次植入的一级预防 ICD 和心脏再同步治疗除颤器（CRT-D）患者（n=2935）。通过丹麦处方登记处获取β受体阻滞剂的使用情况、类型和剂量。根据指南建议，我们将目标日剂量定义为≥50mg卡维地洛和≥200mg美托洛尔。在植入前，2935 例患者中有 2427 例（83%）接受了β受体阻滞剂治疗，其中 2166 例（89%）在植入前 3 个月或更早开始治疗。大多数患者接受卡维地洛（52%）或美托洛尔（41%）治疗。服用卡维地洛的患者达到目标剂量的频率高于服用美托洛尔的患者，植入时服用卡维地洛的患者中有 39%，服用美托洛尔的患者中有 26%（所有时间点 P<0.001）。植入 ICD 后，服用卡维地洛和美托洛尔的患者达到目标日剂量的比例均有所增加。植入时服用β受体阻滞剂的患者达到目标剂量的比例较高，服用血管紧张素转换酶抑制剂和/或螺内酯、无心肌梗死史、年龄较小和心力衰竭症状较轻也是达到目标剂量的重要预测因素。
在一级预防 ICD 患者的真实环境中，39%和 26%的患者在植入前被滴定至卡维地洛或美托洛尔的最佳目标剂量。与美托洛尔相比，服用卡维地洛的患者达到目标剂量的比例更高。
