Laboratory for Experimental Cardiology, Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
Heart. 2021 Nov;107(21):1748-1755. doi: 10.1136/heartjnl-2021-319229. Epub 2021 Jul 14.
Women with heart failure with reduced ejection fraction (HFrEF) may reach optimal treatment effect at half of the guideline-recommended medication dose. This study investigates prescription practice and its relation with survival of patients with HF in daily care.
Electronic health record data from 13 Dutch outpatient cardiology clinics were extracted for HF receiving at least one guideline-recommended HF medication. Dose changes over consecutive prescriptions were modelled using natural cubic splines. Inverse probability-weighted Cox regression was used to assess the relationship between dose (reference≥50% target dose) and all-cause mortality.
The study population comprised 561 women (29% HFrEF (ejection fraction (EF)<40%), 49% heart failure with preserved ejection fraction (EF≥50%); HFpEF and 615 men (47% and 25%, respectively). During a median follow-up of 3.7 years, 252 patients died (48% women; 167 HFrEF, 84 HFpEF). Nine hundred thirty-four patients (46% women) received ACE inhibitors (ACEIs) or angiotensin receptor blockers (ARBs), 795 (48% women) beta blockers and 178 (42% women) mineralocorticoid receptor antagonists (MRAs). In both sexes, the mean target dose across prescriptions was 50% for ACEI/ARBs and beta blockers, and 100% for MRAs. ACEI/ARB dose of <50% was associated with lower mortality in women but not in men with HFrEF. This was not seen in patients with HFpEF. Beta-blocker dose was not associated with all-cause mortality.
Patients with HF seen in outpatient cardiology clinics receive half of the guideline-recommended medication dose. Lower ACEI/ARB dose was associated with improved survival in women with HFrEF. These results underscore the importance of (re)defining optimal medical therapy for women with HFrEF.
射血分数降低的心力衰竭（HFrEF）女性患者可能只需接受指南推荐药物剂量的一半即可达到最佳治疗效果。本研究旨在调查日常护理中 HF 患者的处方实践及其与生存率的关系。
从 13 家荷兰门诊心脏病学诊所的电子健康记录中提取至少接受一种指南推荐 HF 药物治疗的 HF 患者的数据。使用自然三次样条对连续处方中的剂量变化进行建模。使用逆概率加权 Cox 回归评估剂量（参考≥50%目标剂量）与全因死亡率之间的关系。
研究人群包括 561 名女性（29%为 HFrEF（射血分数（EF）<40%），49%为射血分数保留性心力衰竭（EF≥50%）；HFpEF）和 615 名男性（分别为 47%和 25%）。中位随访 3.7 年后，252 名患者死亡（48%为女性；167 名 HFrEF，84 名 HFpEF）。934 名患者（46%为女性）接受了血管紧张素转换酶抑制剂（ACEIs）或血管紧张素受体阻滞剂（ARBs），795 名患者（48%为女性）接受了β受体阻滞剂，178 名患者（42%为女性）接受了盐皮质激素受体拮抗剂（MRAs）。在男性和女性中，ACEI/ARB 和β受体阻滞剂的处方平均目标剂量均为 50%，而 MRA 的平均目标剂量为 100%。女性 HFrEF 患者 ACEI/ARB 剂量<50%与死亡率降低相关，但男性 HFrEF 患者则不然。HFpEF 患者未见这种情况。β受体阻滞剂剂量与全因死亡率无关。
在门诊心脏病学诊所就诊的 HF 患者接受了指南推荐药物剂量的一半。HFrEF 女性患者 ACEI/ARB 剂量较低与生存率提高相关。这些结果强调了为 HFrEF 女性重新定义最佳药物治疗的重要性。
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