Yamaguchi Tetsuo, Kitai Takeshi, Miyamoto Takamichi, Kagiyama Nobuyuki, Okumura Takahiro, Kida Keisuke, Oishi Shogo, Akiyama Eiichi, Suzuki Satoshi, Yamamoto Masayoshi, Yamaguchi Junji, Iwai Takamasa, Hijikata Sadahiro, Masuda Ryo, Miyazaki Ryoichi, Hara Nobuhiro, Nagata Yasutoshi, Nozato Toshihiro, Matsue Yuya
Department of Cardiology, Japanese Red Cross Musashino Hospital, Tokyo, Japan.
Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan; Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
Am J Cardiol. 2018 Apr 15;121(8):969-974. doi: 10.1016/j.amjcard.2018.01.006. Epub 2018 Feb 21.
Guideline-directed medical therapy (GDMT) is recommended for patients with heart failure with reduced ejection fraction (HFrEF). However, the prognostic impact of medication optimization at the time of discharge in patients hospitalized with heart failure (HF) is unclear. We analyzed 534 patients (73 ± 13 years old) with HFrEF. The status of GDMT at the time of discharge (prescription of angiotensin converting enzyme inhibitor [ACE-I]/angiotensin receptor blocker [ARB] and β blocker [BB]) and its association with 1-year all-cause mortality and HF readmission were investigated. Patients were divided into 3 groups: those treated with both ACE-I/ARB and BB (Both group: n = 332, 62%), either ACE-I/ARB or BB (Either group: n = 169, 32%), and neither ACE-I/ARB nor BB (None group: n = 33, 6%), respectively. One-year mortality, but not 1-year HF readmission rate, was significantly different in the 3 groups, in favor of the Either and Both groups. A favorable impact of being on GDMT at the time of discharge on 1-year mortality was retained even after adjustment for covariates (Either group: hazard ratio [HR] 0.44, 95% confidence interval [CI] 0.21 to 0.90, p = 0.025 and Both group: HR 0.29, 95% CI 0.13-0.65, p = 0.002, vs None group). For 1-year HF readmission, no such association was found. In conclusion, optimization of GDMT before the time of discharge was associated with a lower 1-year mortality, but not with HF readmission rate, in patients hospitalized with HFrEF.
对于射血分数降低的心力衰竭（HFrEF）患者，推荐采用指南指导的药物治疗（GDMT）。然而，心力衰竭（HF）住院患者出院时药物优化对预后的影响尚不清楚。我们分析了534例HFrEF患者（73±13岁）。研究了出院时GDMT的状态（血管紧张素转换酶抑制剂[ACE-I]/血管紧张素受体阻滞剂[ARB]和β受体阻滞剂[BB]的处方情况）及其与1年全因死亡率和心力衰竭再入院的关系。患者分为3组：同时接受ACE-I/ARB和BB治疗的患者（两者均用组：n = 332，62%）、接受ACE-I/ARB或BB治疗的患者（二者选一用组：n = 169，32%）以及既未接受ACE-I/ARB也未接受BB治疗的患者（二者均未用组：n = 33，6%）。3组患者的1年死亡率存在显著差异，有利于二者选一用组和两者均用组，但1年心力衰竭再入院率无显著差异。即使在对协变量进行调整后，出院时接受GDMT对1年死亡率仍有有利影响（二者选一用组：风险比[HR] 0.44，95%置信区间[CI] 0.21至0.90，p = 0.025；两者均用组：HR 0.29，95% CI 0.13 - 0.65，p = 0.002，与二者均未用组相比）。对于1年心力衰竭再入院，未发现此类关联。总之，在HFrEF住院患者中，出院前GDMT的优化与较低的1年死亡率相关，但与心力衰竭再入院率无关。
