Department of Anesthesiology and Critical Care, APHP - Saint Louis Lariboisière University Hospitals, University Paris Diderot and INSERM UMR-S 942, Paris, France.
Division of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland.
Eur J Heart Fail. 2018 Feb;20(2):345-354. doi: 10.1002/ejhf.932. Epub 2017 Aug 28.
Heart failure oral therapies (HFOTs), including beta-blockers (BB), renin-angiotensin system inhibitors (RASi) and mineralocorticoid receptor antagonists, administered before hospital discharge after acute heart failure (AHF) might improve outcome. However, concerns have been raised because early administration of HFOTs may worsen patient's condition. We hypothesized that HFOTs at hospital discharge might be associated with better post-discharge survival.
The study population was composed of 19 980 AHF patients from the GREAT registry. The primary and secondary outcomes were 90-day and 1-year all-cause mortality, respectively. Survival was estimated with univariate and covariate-adjusted Cox proportional hazards regression models for the whole population and after propensity-score matching. HFOTs at discharge were consistently associated with no excess mortality in the unadjusted and adjusted analyses of the whole and matched cohorts. In the matched cohort, BB and RASi at discharge were associated with lower 90-day mortality risks compared to the respective untreated groups [hazard ratio (HR) 0.56, 95% confidence interval (CI) 0.46-0.69; and HR 0.53, 95% CI 0.42-0.66, respectively]. The favourable associations of BB and RASi at discharge with 90-day mortality were present in many subgroups including patients with reduced or preserved left ventricular ejection fraction and persisted up to 1 year after discharge. The combination of RASi and BB was associated with an even lower risk of death than RASi or BB alone.
Administration of HFOTs at hospital discharge is associated with better survival of AHF patients.
心力衰竭口服治疗药物（HFOTs），包括β受体阻滞剂（BB）、肾素-血管紧张素系统抑制剂（RASi）和盐皮质激素受体拮抗剂，在急性心力衰竭（AHF）后出院前使用，可能改善预后。然而，人们对此表示担忧，因为 HFOTs 的早期应用可能会使患者病情恶化。我们假设 HFOTs 在出院时可能与更好的出院后生存相关。
研究人群由 GREAT 注册研究中的 19980 例 AHF 患者组成。主要和次要结局分别为 90 天和 1 年全因死亡率。使用单变量和协变量调整的 Cox 比例风险回归模型对整个人群和倾向评分匹配后的人群进行生存估计。在未调整和调整后的整个队列和匹配队列分析中，HFOTs 在出院时与死亡率无显著增加相关。在匹配队列中，与未治疗组相比，BB 和 RASi 在出院时与 90 天死亡率降低相关[风险比（HR）0.56，95%置信区间（CI）0.46-0.69；HR 0.53，95% CI 0.42-0.66]。BB 和 RASi 在出院时与 90 天死亡率的有利关联存在于许多亚组中，包括左心室射血分数降低或保留的患者，并且在出院后 1 年内仍然存在。RASi 和 BB 的联合使用与单独使用 RASi 或 BB 相比，死亡风险更低。
HFOTs 在出院时的应用与 AHF 患者的生存改善相关。
