Department of Cardiology, Angiology, and Pulmology, University of Heidelberg, Im Neuenheimer Feld 410, 69221, Heidelberg, Germany.
Medizinische Klinik B-Abteilung für Kardiologie, Klinikum der Stadt Ludwigshafen GmbH, Ludwigshafen am Rhein, 67059, Germany.
Clin Res Cardiol. 2018 Nov;107(11):1040-1049. doi: 10.1007/s00392-018-1277-4. Epub 2018 May 17.
Beta blockers improve survival in patients with chronic systolic heart failure (CHF). Whether physicians should aim for target dose, target heart rate (HR), or both is still under debate.
We identified 1,669 patients with systolic CHF due to ischemic heart disease or idiopathic dilated cardiomyopathy from the University Hospital Heidelberg and the Clinic of Ludwigshafen, Germany. All patients were treated with an angiotensin converting enzyme inhibitor or angiotensin receptor blocker and had a history of CHF known for at least 6 months. Target dose was defined as treatment with ≥ 95% of the respective published guideline-recommended dose. Target HR was defined as 51-69 bpm. All-cause mortality during the median follow-up of 42.8 months was analysed with respect to beta blocker dosing and resting HR. 201 (12%) patients met the dose target (group A), 285 (17.1%) met the HR target (group B), 627 (37.6%) met no target (group C), and 556 (33.3%) did not receive beta blockers (Group D). 5-year mortality was 23.7, 22.7, 37.6, and 55.6% for group A, B, C, and D, respectively (p < 0.001). Survival for group A patients with a HR ≥ 70 bpm was 28.8% but 14.8% if HR was 50-70 bpm (p = 0.054).
Achieving guidelines recommended beta blocker dose or to HR control has a similar positive impact on survival. When on target dose, supplemental HR control additionally improves survival.
β受体阻滞剂可改善慢性收缩性心力衰竭（CHF）患者的生存率。医生是否应追求目标剂量、目标心率（HR）或两者兼顾仍存在争议。
我们从德国海德堡大学医院和路德维希港诊所确定了 1669 名患有缺血性心脏病或特发性扩张型心肌病的收缩性 CHF 患者。所有患者均接受血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂治疗，且 CHF 病史至少 6 个月。目标剂量定义为接受各自发表的指南推荐剂量的≥95%。目标 HR 定义为 51-69bpm。在中位随访 42.8 个月期间，分析了所有原因死亡率与β受体阻滞剂剂量和静息 HR 的关系。201 名（12%）患者达到剂量目标（A 组），285 名（17.1%）达到 HR 目标（B 组），627 名（37.6%）未达到目标（C 组），556 名（33.3%）未接受β受体阻滞剂（D 组）。A、B、C 和 D 组的 5 年死亡率分别为 23.7%、22.7%、37.6%和 55.6%（p<0.001）。A 组 HR≥70bpm 的患者生存率为 28.8%，但 HR 为 50-70bpm 的患者生存率为 14.8%（p=0.054）。
达到指南推荐的β受体阻滞剂剂量或 HR 控制对生存率有相似的积极影响。在达到目标剂量时，补充 HR 控制可进一步提高生存率。
