基于证据的医学在急性心力衰竭中应用时间的影响：一项全国性队列研究。

Impact of the duration of the evidence-based medicine use in acute heart failure: A nationwide cohort study.

机构信息

Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.

Department of Internal Medicine, Faculty of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.

出版信息

PLoS One. 2018 Oct 11;13(10):e0205440. doi: 10.1371/journal.pone.0205440. eCollection 2018.

DOI:10.1371/journal.pone.0205440

PMID:30308032

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6181363/

Abstract

BACKGROUND

Several randomized control trials have established that drugs can decrease the heart failure (HF) rehospitalization in patients with HF. However, limited studies have investigated the duration of medicine use to decrease the rehospitalization period in the real world. Hence, this study aims to investigate whether the evidence-based medicine decreases the HF rehospitalization in different treatment intervals in the clinical practice.

METHOD

We examined patients admitted with acute HF from the National Health Insurance Research Database in Taiwan. In addition, the major adverse cardiovascular events (MACE) were the composite endpoints of the in-hospital mortality and rehospitalization after 1 year. Furthermore, we analyzed the medicine use to decrease 14 days and 1, 6, and 12 months' HF rehospitalization.

RESULTS

Overall, we examined 11,012 patients. The use of the renin-angiotensin system (RAS) blockers [hazard ratio (HR), 0.58; P < 0.01], β-blocker (HR, 0.67; P < 0.01), spironolactone (HR, 0.63; P < 0.01), and digitalis (HR, 0.67; P < 0.01) associated with the lower in-hospital mortality rate. The Cox regression analysis revealed that RAS blocker (HR, 0.86; P < 0.01) and β-blocker (HR, 0.71; P < 0.01) were independent predictors for MACE. Although RAS blockers declined rehospitalization to 6 months, β-blocker decreased the rehospitalization rate after 1 month use and the benefit persisted till 12 months. Furthermore, digitalis only lowered rehospitalization to 14 days.

CONCLUSION

This study suggests that the use of evidence-based medicine is associated with lower MACE for patients with HF, and these drugs could play vital roles in different periods to decrease the rehospitalization in the clinical setting.

摘要

背景

几项随机对照试验已经证实，药物可以降低心力衰竭（HF）患者的心力衰竭再住院率。然而，有限的研究调查了药物使用的持续时间，以减少真实世界中的再住院期。因此，本研究旨在调查在临床实践中，基于证据的药物是否会在不同的治疗间隔内降低心力衰竭的再住院率。

方法

我们从台湾国家健康保险研究数据库中检查了因急性心力衰竭入院的患者。此外，主要不良心血管事件（MACE）是住院期间死亡率和 1 年后再住院的复合终点。此外，我们分析了降低 14 天、1、6 和 12 个月心力衰竭再住院率的药物使用情况。

结果

总体而言，我们检查了 11012 名患者。肾素-血管紧张素系统（RAS）阻滞剂的使用[风险比（HR），0.58；P < 0.01]、β-受体阻滞剂（HR，0.67；P < 0.01）、螺内酯（HR，0.63；P < 0.01）和地高辛（HR，0.67；P < 0.01）与较低的住院死亡率相关。Cox 回归分析显示，RAS 阻滞剂（HR，0.86；P < 0.01）和β-受体阻滞剂（HR，0.71；P < 0.01）是 MACE 的独立预测因素。尽管 RAS 阻滞剂将再住院率降低至 6 个月，但β-受体阻滞剂在使用 1 个月后降低了再住院率，且这种益处持续到 12 个月。此外，地高辛仅将再住院率降低至 14 天。