Desta Liyew, Khedri Masih, Jernberg Tomas, Andell Pontus, Mohammad Moman Aladdin, Hofman-Bang Claes, Erlinge David, Spaak Jonas, Persson Hans
Department of Cardiology, Heart and Vascular Theme, Karolinska University Hospital, SE-141 86, Stockholm, Sweden.
Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, Stockholm, Sweden.
ESC Heart Fail. 2021 Feb;8(1):344-355. doi: 10.1002/ehf2.13079. Epub 2020 Dec 1.
The aim of this study is to investigate the association between adherence to beta-blocker treatment after a first acute myocardial infarction (AMI) and long-term risk of heart failure (HF) and death.
All patients admitted for a first AMI included in the nationwide Swedish web-system for enhancement and development of evidence-based care in heart disease evaluated according to recommended therapies register between 2005 and 2010 were eligible (n = 71 638). After exclusion of patients who died in-hospital, patients with previous HF, patients with unknown left ventricular ejection fraction (EF), and patients who died during the first year after the index event, 38 608 patients remained in the final analysis. Adherence to prescribed beta-blockers was determined for 1 year after the index event using the national registry for prescribed drugs and was measured as proportion of days covered, the ratio between the numbers of days covered by the dispensed prescriptions and number of days in the period. As customary, a threshold level for proportion of days covered ≥80% was used to classify patients as adherent or non-adherent. At discharge 90.6% (n = 36 869) of all patients were prescribed a beta-blocker. Among 38 608 1 year survivors, 31.1% (n = 12 013) were non-adherent to beta-blockers. Patients with reduced EF with and without HF were more likely to remain adherent to beta-blockers at 1-year compared with patients with normal EF without HF (NEF). Being married/cohabiting and having higher income level, hypertension, ST-elevation MI, and percutaneous coronary intervention were associated with better adherence. Adherence was independently associated with lower all-cause mortality [hazard ratio (HR) 0.77, 95% confidence interval [CI] 0.71-0.84] and a lower risk for the composite of HF readmission/death, (HR 0.83, 95% CI 0.78-0.89, P value <0.001) during the subsequent 4 years of follow up. These associations were favourable but less apparent in patients with HFNEF and NEF.
Nearly one in three AMI patients was non-adherent to beta-blockers within the first year. Adherence was independently associated with improved long-term outcomes; however, uncertainty remains for patients with HFNEF and NEF.
本研究旨在调查首次急性心肌梗死（AMI）后β受体阻滞剂治疗的依从性与心力衰竭（HF）和死亡的长期风险之间的关联。
纳入2005年至2010年期间在瑞典全国性网络系统中登记的、根据推荐疗法评估的首次AMI住院患者（n = 71638）。排除住院死亡患者、既往有HF患者、左心室射血分数（EF）未知患者以及在索引事件后第一年内死亡的患者后，最终分析纳入38608例患者。使用国家处方药登记系统确定索引事件后1年内患者对处方β受体阻滞剂的依从性，以覆盖天数比例衡量，即所配处方覆盖天数与该时间段天数之比。按照惯例，使用覆盖天数比例≥80%的阈值将患者分类为依从或不依从。出院时，所有患者中有90.6%（n = 36869）被处方β受体阻滞剂。在38608例1年幸存者中，31.1%（n = 12013）未依从β受体阻滞剂治疗。与EF正常且无HF（NEF）的患者相比，EF降低且有或无HF的患者在1年时更可能持续依从β受体阻滞剂治疗。已婚/同居、收入水平较高、患有高血压、ST段抬高型心肌梗死以及接受经皮冠状动脉介入治疗与更好的依从性相关。依从性与较低的全因死亡率[风险比（HR）0.77，95%置信区间（CI）0.71 - 0.84]以及随后4年随访期间HF再入院/死亡复合事件的较低风险（HR 0.83，95% CI 0.78 - 0.89，P值<0.001）独立相关。这些关联是有利的，但在HFNEF和NEF患者中不太明显。
近三分之一的AMI患者在第一年内未依从β受体阻滞剂治疗。依从性与改善的长期结局独立相关；然而，HFNEF和NEF患者仍存在不确定性。
