Erickson Marc, O'Dell Kimberly, Malpartida Juan Carlos, Mok Jacob, Khan Rafay, Patel Dharmendra
Department of Cardiology, University of Tennessee at Chattanooga, 975 E 3rd Street, Chattanooga, TN 37403, USA.
Cardiol Res. 2021 Feb;12(1):2-9. doi: 10.14740/cr1169. Epub 2020 Dec 11.
Heart failure with reduced ejection fraction (HFrEF) is associated with recurrent hospitalizations and high mortality. Guideline-directed medical therapy (GDMT) reduces morbidity, mortality and re-admission rates. Despite the evidence, less than 50% of patients with HFrEF are prescribed appropriate medical therapy. When hospitalized patients have these medications discontinued on admission or during hospitalization, they are less likely to have them restarted on discharge. The goal of this study was to determine the incidence of disruption of beta-blocker (BB) therapy during hospitalization for HFrEF patients admitted to an academic tertiary referral hospital.
We conducted a retrospective study in a single teaching hospital over the course of 1 year, and utilized data queried from the electronic medical record (EPIC) database. Inclusion criteria were met by patients with an ICD-10 code diagnosis of heart failure, left ventricular ejection fraction less than 40% and BB prescription prior to admission. Additional information noted included age, sex, vital signs throughout the admission and dates where BB was not given for a full 24-h period. Patients in the intensive care unit (ICU) were excluded due to uncertainty of their hemodynamics. Data were extracted from the electronic medical record database and analyzed through Python, Microsoft Excel and RStudio. The incidence of BB disruption during hospitalization was defined as a 24-h period where no BB was administered. Blood pressure (BP) and heart rate (HR) levels were compared between patients who received BB and patients who had a disruption in their BB. Measurements were also obtained to assess whether a correlation exists between holding BB therapy and time of the year, age, or sex.
Between January 2018 and January 2019, 780 patient encounters met inclusion criteria for the study. Patients who were continued on BB therapy had an average BP of 120.8/68.7 mm Hg and an HR of 82.4 bpm on days they received their BB. Patients who had a disruption of BB therapy had an average BP of 117.7/67.6 mm Hg and an HR of 88.6 bpm on the days of the disruption (P < 0.001). There was no association between holding BB and age, sex, or time of year.
This study showed that in an academic tertiary referral center, patients with HFrEF who are not in an ICU have a 23% chance of not receiving their recommended BB therapy for 24 h. While the differences measured for BP and HR are statistically significant, they are not clinically significant.
射血分数降低的心力衰竭（HFrEF）与反复住院和高死亡率相关。指南指导的药物治疗（GDMT）可降低发病率、死亡率和再入院率。尽管有证据支持，但只有不到50%的HFrEF患者接受了适当的药物治疗。当住院患者在入院时或住院期间停用这些药物后，出院时重新开始使用的可能性较小。本研究的目的是确定在一所学术性三级转诊医院住院的HFrEF患者中，β受体阻滞剂（BB）治疗中断的发生率。
我们在一家教学医院进行了为期1年的回顾性研究，并利用从电子病历（EPIC）数据库中查询的数据。纳入标准为ICD-10编码诊断为心力衰竭、左心室射血分数低于40%且入院前开具了BB处方的患者。记录的其他信息包括年龄、性别、入院期间的生命体征以及BB未完整给药24小时的日期。重症监护病房（ICU）的患者因血流动力学情况不确定而被排除。数据从电子病历数据库中提取，并通过Python、Microsoft Excel和RStudio进行分析。住院期间BB中断的发生率定义为未给予BB的24小时时间段。比较接受BB治疗的患者和BB治疗中断的患者之间的血压（BP）和心率（HR）水平。还进行了测量以评估停用BB治疗与一年中的时间、年龄或性别之间是否存在相关性。
在2018年1月至2019年1月期间，780例患者符合该研究的纳入标准。继续接受BB治疗的患者在接受BB治疗的日子里平均血压为120.8/68.7 mmHg，心率为82.4次/分钟。BB治疗中断的患者在中断当天平均血压为117.7/67.6 mmHg，心率为88.6次/分钟（P<0.001）。停用BB与年龄、性别或一年中的时间之间没有关联。
本研究表明，在一所学术性三级转诊中心，非ICU的HFrEF患者有23%的几率在24小时内未接受推荐的BB治疗。虽然测量的血压和心率差异具有统计学意义，但在临床上并不显著。
