β受体阻滞剂在射血分数中间值的心衰住院患者中 1 年结局的影响。
β-blocker and 1-year outcomes among patients hospitalized for heart failure with mid-range ejection fraction.
机构信息
National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Building C, Fengcunxili 15, Mentougou District, Beijing 102308, China.
出版信息
Eur Heart J Cardiovasc Pharmacother. 2022 Feb 16;8(2):140-148. doi: 10.1093/ehjcvp/pvab029.
AIMS
The beneficial effect of β-blocker on heart failure with reduced ejection fraction is well established. However, its effect on the 1-year outcome of heart failure with mid-range ejection fraction (HFmrEF) remains unclear.
METHODS AND RESULTS
We analysed the data of the patients with left ventricular ejection fraction (LVEF) between 40% and 49% in China Patient-centred Evaluative Assessment of Cardiac Events Prospective Heart Failure Study (China PEACE 5p-HF Study), in which patients hospitalized for heart failure from 52 Chinese hospitals were recruited from 2016 to 2018. Two primary outcomes were all-cause death and all-cause hospitalization. The associations between β-blocker use at discharge and outcomes were assessed by inverse probability of treatment weighting (IPTW)-weighted Cox regression analyses. To assess consistency, IPTW adjusting medications analyses, multivariable analyses and dose-effect analyses were performed. A total of 1035 HFmrEF patients were included in the analysis. The mean age was 65.5 ± 12.7 years and 377 (36.4%) were female. The median (interquartile range) of LVEF was 44% (42-47%). Six hundred and sixty-one (63.8%) were treated with β-blocker. Patients using β-blocker were younger with better cardiac function, and more likely to use renin-angiotensin system inhibitor and mineralocorticoid receptor antagonist. During the 1-year follow-up, death occurred in 84 (12.7%) treated and 85 (22.7%) untreated patients (P < 0.0001); all-cause hospitalization occurred in 298 (45.1%) treated and 188 (50.3%) untreated patients (P = 0.04). After IPTW-weighted adjustment, β-blocker use was significantly associated with lower risk of all-cause death [hazard ratio (HR): 0.70; 95% confidence interval (CI): 0.51-0.96, P = 0.03], but not with lower all-cause hospitalization (HR, 0.92, 95% CI, 0.76-1.10, P = 0.36). Consistency analyses showed consistent favourable effect of β-blocker on all-cause death, but not on all-cause hospitalization.
CONCLUSIONS
Among patients with HFmrEF, β-blocker use was associated with lower risk of all-cause death, but not with lower risk of all-cause hospitalization.
目的
β受体阻滞剂对射血分数降低的心力衰竭有益已得到充分证实。然而，其对射血分数中间范围的心力衰竭（HFmrEF）的 1 年结局的影响尚不清楚。
方法和结果
我们分析了中国心力衰竭患者生存质量注册研究（China PEACE 5p-HF 研究）中左心室射血分数（LVEF）介于 40%至 49%的患者数据。该研究于 2016 年至 2018 年期间从中国 52 家医院招募因心力衰竭住院的患者。主要复合终点为全因死亡和全因住院。通过逆概率处理加权（Inverse Probability of Treatment Weighting，IPTW）加权 Cox 回归分析评估出院时使用β受体阻滞剂与结局的相关性。为评估一致性，还进行了 IPTW 调整药物分析、多变量分析和剂量-效应分析。共纳入 1035 例 HFmrEF 患者。平均年龄为 65.5±12.7 岁，377 例（36.4%）为女性。LVEF 的中位数（四分位距）为 44%（42%-47%）。661 例（63.8%）接受β受体阻滞剂治疗。使用β受体阻滞剂的患者年龄较小，心功能较好，更有可能使用肾素-血管紧张素系统抑制剂和盐皮质激素受体拮抗剂。在 1 年随访期间，治疗组有 84 例（12.7%）和未治疗组有 85 例（22.7%）患者死亡（P<0.0001）；治疗组有 298 例（45.1%）和未治疗组有 188 例（50.3%）患者全因住院（P=0.04）。经 IPTW 加权调整后，β受体阻滞剂的使用与较低的全因死亡风险显著相关[风险比（hazard ratio，HR）：0.70；95%置信区间（confidence interval，CI）：0.51-0.96，P=0.03]，但与全因住院风险无关（HR：0.92，95%CI：0.76-1.10，P=0.36）。一致性分析表明，β受体阻滞剂对全因死亡有一致的有利影响，但对全因住院无影响。
结论
在 HFmrEF 患者中，β受体阻滞剂的使用与较低的全因死亡风险相关，但与较低的全因住院风险无关。
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