APEMAC, Université de Lorraine, 54000, Nancy, France.
CHRU-Nancy, INSERM, Université de Lorraine, CIC, Epidémiologie Clinique, 54000, Nancy, France.
Eur J Clin Pharmacol. 2021 Oct;77(10):1569-1581. doi: 10.1007/s00228-021-03153-6. Epub 2021 May 10.
The aims of this study were to describe combinations of beta-blockers (BB), renin-angiotensin system (RAS) blockers, and mineralocorticoid receptor antagonist (MRA) prescriptions and their trajectories in heart failure with preserved ejection fraction (HFpEF) patients, and to assess their effect on the three-year all-cause and cardiovascular (CV)-mortality.
We used data from the EPICAL2 cohort of 689 hospitalized HFpEF patients. Medication prescriptions were collected at hospital discharge and at 6, 12, and 24 months after discharge. A multi-trajectory approach was used to conjointly model groups of individuals following similar trajectories over medications prescriptions. We used Cox and Fine-Gray models, to evaluate respectively the associations between 3-year all-cause mortality and CV-mortality and the trajectory groups.
Multi-trajectory modelling revealed five distinct trajectory groups: group1 (N = 232, 33.6%) stable ACEI/ARB and BB prescriptions, group 2 (N = 199, 28.8%) stable ACEI/ARB prescription, group 3 (N = 133, 19.3%) stable BB prescriptions, group 4 (N = 78, 11.3%) stable prescriptions of none of the medications, and group 5 (N = 47, 6.8%) stable ACEI/ARB, BB, and MRA prescriptions. As compared to the group 4 of patients receiving none of the three medications, patients receiving a stable prescription of one or a combination of two or the three medications over 2 years) had a lower overall mortality over 3-year follow-up, i.e., group 1 (HR = 0.5, 95% CI 0.4-0.8), group 2 (HR = 0.6, 95% CI:0.4-0.8), group 3 (HR = 0.5, 95% CI:0.4-0.7), and group 5 (HR = 0.5, 95% CI:0.3-0.9). However, none of these trajectory groups was associated with a lower CV-mortality over 3 years.
In an unselected population-based sample of HFpEF patients, the long-term stable use of the combination ACEI/ARB and BB, BB exclusively, ACEI/ARB exclusively, or the combination ACEI/ARB and BB and MRAs was associated with reduced three-year all-cause mortality.
本研究旨在描述心力衰竭射血分数保留（HFpEF）患者β受体阻滞剂（BB）、肾素-血管紧张素系统（RAS）阻滞剂和盐皮质激素受体拮抗剂（MRA）联合用药的组合方案及其变化趋势，并评估其对 3 年全因和心血管（CV）死亡率的影响。
我们使用了来自 EPICAL2 队列的 689 例住院 HFpEF 患者的数据。在出院时以及出院后 6、12 和 24 个月时收集药物处方。采用多轨迹方法对药物处方相似的个体群体进行联合建模。我们使用 Cox 和 Fine-Gray 模型分别评估 3 年全因死亡率和 CV 死亡率与轨迹组之间的关联。
多轨迹建模显示存在五个不同的轨迹组：组 1（N=232，33.6%）稳定的 ACEI/ARB 和 BB 处方，组 2（N=199，28.8%）稳定的 ACEI/ARB 处方，组 3（N=133，19.3%）稳定的 BB 处方，组 4（N=78，11.3%）稳定的三种药物均未使用处方，组 5（N=47，6.8%）稳定的 ACEI/ARB、BB 和 MRA 处方。与组 4 未使用三种药物相比，在 2 年内稳定使用一种或两种或三种药物的患者在 3 年随访期间的总死亡率较低，即组 1（HR=0.5，95%CI 0.4-0.8）、组 2（HR=0.6，95%CI：0.4-0.8）、组 3（HR=0.5，95%CI：0.4-0.7）和组 5（HR=0.5，95%CI：0.3-0.9）。然而，这些轨迹组均与 3 年内较低的 CV 死亡率无关。
在 HFpEF 患者的未选择的基于人群的样本中，长期稳定使用 ACEI/ARB 和 BB 联合用药、仅使用 BB、仅使用 ACEI/ARB 或 ACEI/ARB 和 BB 联合用药以及 MRA 与降低 3 年全因死亡率相关。
