Department of Pharmacotherapy and Translational Research, Center for Pharmacogenomics and Precision Medicine, University of Florida College of Pharmacy, Gainesville, FL.
Division of Cardiology, Department of Medicine, University of Illinois at Chicago College of Medicine, Chicago, IL; and.
J Cardiovasc Pharmacol. 2020 Mar;75(3):250-258. doi: 10.1097/FJC.0000000000000779.
Heart failure (HF) is highly prevalent and a major cause of death in the United States. The effect of HF medications on survival has been predicted by validated models studied in populations predominantly of European descent. This study aimed to identify medications associated with survival in a racially diverse HF population. Patients with HF were recruited and followed from 2001 to 2015. Data were collected from electronic health records and the Social Security Death Index. The primary analysis tested the association between medication dose and all-cause mortality, with a secondary analysis assessing the composite outcome of death or cardiac-related hospitalization. Circulating concentration of the fibrotic marker procollagen type III N-terminal peptide (PIIINP) was also compared with medication doses in patients with concentrations available. The study population consisted of 337 patients, of which 25.2% died and 46% were hospitalized. Increased beta-blocker (BB) dose was significantly associated with survival in the base model [hazard ratio (HR) = 0.71, P = 0.017] and marginally associated in the comprehensive model (HR = 0.75, P = 0.068). BB dose was also associated with decreased risk of the composite end point in the base model (HR = 0.80, P = 0.029) and to a lesser extent in the comprehensive model (HR = 0.83, P = 0.085). Furthermore, increased BB dose was inversely associated with circulating PIIINP concentration (P = 0.041). In conclusion, our study highlights the importance of BB dose escalation for survival and decreased hospitalization in patients with HF, regardless of race or HF type. It also suggests that benefits observed with high-dose BBs could be mediated, at least in part, by decreased cardiac fibrosis.
心力衰竭（HF）在美国的发病率很高，是主要的死亡原因之一。在以欧洲裔为主的人群中进行验证模型研究，预测了 HF 药物对生存率的影响。本研究旨在确定与种族多样化 HF 人群生存率相关的药物。从 2001 年到 2015 年，招募并随访了 HF 患者。数据来自电子健康记录和社会保障死亡索引。主要分析测试了药物剂量与全因死亡率之间的关系，次要分析评估了死亡或与心脏相关的住院的复合结果。在有浓度数据的患者中，还比较了循环纤维化标志物 III 型前胶原 N 端肽（PIIINP）的浓度与药物剂量之间的关系。研究人群包括 337 名患者，其中 25.2%死亡，46%住院。基础模型中 BB 剂量增加与生存率显著相关[风险比（HR）=0.71，P=0.017]，综合模型中略有相关（HR=0.75，P=0.068）。基础模型中 BB 剂量也与复合终点风险降低相关（HR=0.80，P=0.029），在综合模型中相关性较小（HR=0.83，P=0.085）。此外，BB 剂量增加与循环 PIIINP 浓度呈负相关（P=0.041）。总之，本研究强调了 HF 患者 BB 剂量递增对生存率和住院减少的重要性，无论种族或 HF 类型如何。它还表明，高剂量 BB 观察到的益处可能至少部分通过减少心脏纤维化来介导。
