Université de Lorraine, CHRU de Nancy, Intensive Care Medicine Babois, FCRIN INI-CRCT, Nancy, France.
INSERM, UMR-S 942, MASCOT, FCRIN INI-CRCT, Paris, France.
Eur J Heart Fail. 2021 Mar;23(3):420-431. doi: 10.1002/ejhf.2103. Epub 2021 Mar 22.
Acute heart failure (AHF) is frequent and life-threatening disease. However, innovative AHF therapies have remained limited, and care is based on experts' opinion. Temporal trends and benefits of long-term oral cardiovascular medications on AHF outcomes remain uncertain.
This study is registered with PROSPERO (CRD42018099885). A systematic review ranging from 1980 to 2017, searched AHF studies with more than 100 patients that reported death and/or readmission. Primary outcomes were temporal trends, assessed by meta-regression, for 30-day or 1-year all-cause death and/or readmission rates. Secondary outcomes were temporal trends of oral cardiovascular therapies and their influence on primary outcomes. Among the 45 143 studies screened, 285 were included, representing 15 million AHFs. In the past decades, though mortality and readmission remain high, there was a decline in 30-day all-cause death [odds ratio (OR) for a 10-year increment: 0.74, 95% confidence interval (CI) 0.61-0.91; P = 0.004] that persisted at 1 year (OR 0.86, 95% CI 0.77-0.96; P = 0.007), while 30-day and 1-year all-cause readmission rate remained roughly unchanged. Trends of primary outcomes were linear and did not differ among continents. Decline in 1-year all-cause death rate correlated with high proportions of oral or beta-blockers, especially when combined with oral renin-angiotensin-aldosterone system inhibitors, but not with diuretics while trends in readmission remained unchanged with these therapies.
Although AHF outcomes remain poor, the present study revealed global favourable trends of survival after AHF episodes probably associated with greater use of oral neurohormonal antagonists. The present study urges to implement the combination of oral renin-angiotensin-aldosterone system inhibitors and beta-blockers in patients at risk of AHF.
急性心力衰竭（AHF）是一种常见且危及生命的疾病。然而，创新的 AHF 治疗方法仍然有限，治疗主要基于专家意见。长期口服心血管药物对 AHF 结局的影响及其时间趋势尚不确定。
本研究已在 PROSPERO（CRD42018099885）注册。系统检索了 1980 年至 2017 年的 AHF 研究，纳入了超过 100 例报告死亡和/或再入院的患者。主要结局为通过荟萃回归评估的 30 天或 1 年全因死亡率和/或再入院率的时间趋势。次要结局为口服心血管治疗的时间趋势及其对主要结局的影响。在筛选的 45143 项研究中，有 285 项符合纳入标准，共纳入 1500 万例 AHF 患者。在过去几十年中，尽管死亡率和再入院率仍然很高，但 30 天全因死亡率呈下降趋势[每 10 年增加的比值比（OR）为 0.74，95%置信区间（CI）为 0.61-0.91；P=0.004]，这种趋势在 1 年时仍然存在（OR 0.86，95%CI 0.77-0.96；P=0.007），而 30 天和 1 年全因再入院率基本保持不变。主要结局的趋势呈线性，且在各大洲之间无差异。1 年全因死亡率的下降与口服或β受体阻滞剂的高比例相关，尤其是与口服肾素-血管紧张素-醛固酮系统抑制剂联合使用时，但与利尿剂无关，而这些治疗方法对再入院率的趋势没有影响。
尽管 AHF 的预后仍然较差，但本研究显示 AHF 后生存的全球趋势良好，这可能与更多地使用口服神经激素拮抗剂有关。本研究敦促在 AHF 高危患者中实施口服肾素-血管紧张素-醛固酮系统抑制剂和β受体阻滞剂的联合治疗。
