Department of Clinical Pharmacy, Ziekenhuisgroep Twente (Hospital Group Twente), Almelo and Hengelo, the Netherlands.
Medical School Twente, Medisch Spectrum Twente, Enschede, the Netherlands.
PLoS One. 2020 Dec 22;15(12):e0244231. doi: 10.1371/journal.pone.0244231. eCollection 2020.
This study assessed the association between heart failure (HF) medication (angiotensin-converting-enzyme inhibitors (ACEI)/angiotensin-receptor blockers (ARB), beta-blockers (BB), mineralocorticoid-receptor antagonists (MRA) and diuretics) and HF readmissions in a real-world unselected group of patients after a first hospital admission for HF. Furthermore we analysed readmission rates for ACEI versus ARB and for carvedilol versus β1-selective BB and we investigated the effect of HF medication in relation to time since discharge.
Medication at discharge was determined with dispensing data from the Dutch PHARMO Database Network including 22,476 patients with HF between 2001 and 2015. After adjustment for age, gender, number of medications and year of admission no associations were found for users versus non-users of ACEI/ARB (hazard ratio, HR = 1.01; 95%CI 0.96-1.06), BB (HR = 1.00; 95%CI 0.95-1.05) and readmissions. The risk of readmission for patients prescribed MRA (HR = 1.11; 95%CI 1.05-1.16) or diuretics (HR = 1.17; 95%CI 1.09-1.25) was higher than for non-users. The HR for ARB relative to ACEI was 1.04 (95%CI 0.97-1.12) and for carvedilol relative to β1-selective BB 1.33 (95%CI 1.20-1.46). Post-hoc analyses showed a protective effect shortly after discharge for most medications. For example one month post discharge the HR for ACEI/ARB was 0.77 (95%CI 0.69-0.86). Although we did try to adjust for confounding by indication, probably residual confounding is still present.
Patients who were prescribed carvedilol have a higher or at least a similar risk of HF readmission compared to β1-selective BB. This study showed that all groups of HF medication -some more pronounced than others- were more effective immediately following discharge.
本研究评估了心力衰竭（HF）药物（血管紧张素转换酶抑制剂（ACEI）/血管紧张素受体阻滞剂（ARB）、β受体阻滞剂（BB）、盐皮质激素受体拮抗剂（MRA）和利尿剂）与首次因 HF 住院后一组未选择的患者 HF 再入院之间的关联。此外，我们分析了 ACEI 与 ARB 以及卡维地洛与β1-选择性 BB 的再入院率，并研究了 HF 药物治疗与出院后时间的关系。
使用荷兰 PHARMO 数据库网络的配药数据确定出院时的药物使用情况，该网络包含 2001 年至 2015 年间 22476 名 HF 患者。调整年龄、性别、药物数量和入院年份后，ACEI/ARB（危险比[HR] = 1.01；95%CI 0.96-1.06）、BB（HR = 1.00；95%CI 0.95-1.05）和再入院患者使用者与非使用者之间无相关性。处方 MRA（HR = 1.11；95%CI 1.05-1.16）或利尿剂（HR = 1.17；95%CI 1.09-1.25）的患者再入院风险高于非使用者。ARB 相对于 ACEI 的 HR 为 1.04（95%CI 0.97-1.12），卡维地洛相对于β1-选择性 BB 的 HR 为 1.33（95%CI 1.20-1.46）。事后分析显示，大多数药物在出院后不久就有保护作用。例如，出院后一个月 ACEI/ARB 的 HR 为 0.77（95%CI 0.69-0.86）。尽管我们确实尝试了通过指示性调整混杂因素，但可能仍然存在残留混杂因素。
服用卡维地洛的患者 HF 再入院的风险高于或至少与β1-选择性 BB 相同。本研究表明，HF 药物治疗的所有组 - 有些比其他组更明显 - 在出院后立即更有效。
