Frausing Maria Hee Jung Park, Witt Christoffer Tobias, Bakos István, Horváth-Puhó Erzsébet, Løgstrup Brian Bridal, Eiskjær Hans, Nielsen Jens Cosedis, Mols Rikke Elmose
Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Bvld. 99, 8200 Aarhus N, Denmark.
Department of Clinical Medicine, Aarhus University, Aarhus, Palle Juul-Jensens Bvld. 82, 8200 Aarhus N, Denmark.
Eur J Cardiovasc Nurs. 2024 Dec 16;23(8):925-934. doi: 10.1093/eurjcn/zvae083.
Pharmacological therapy remains a cornerstone in heart failure (HF) treatment despite the implantation of a cardiac resynchronization therapy (CRT) device. The aim of this study was to investigate the association between (i) drug discontinuation and (ii) long-term adherence to HF pharmacotherapy after CRT implantation and socioeconomic position and multimorbidity.
We conducted a registry-based cohort study including all patients who underwent a first-time CRT implantation at Aarhus University Hospital from 2000 to 2017. Heart failure pharmacotherapy included beta-blockers (BBs), renin-angiotensin system inhibitors [angiotensin-converting enzyme inhibitor (ACEI)/angiotensin II receptor blocker (ARB)], and mineralocorticoid receptor antagonists (MRAs). Patients were identified using the Danish Pacemaker and International Classification for Disease Registry, and information about medication and comorbidities was obtained through linkage to the Danish health registries. We identified 2007 patients, of whom 1880 (94%) were eligible for inclusion. The cumulative incidence of drug discontinuation at 10 years was 6% [95% confidence interval (CI) 5-8%] for BB, 10% (95% CI 9-12%) for ACEI/ARB, and 24% (95% CI 20-27%) for MRAs. Living alone was associated with higher BB discontinuation rates [hazard ratio (HR) 1.83, 95% CI 1.20-2.79], whereas patients with multimorbidity were more likely to discontinue ACEI/ARB (HR 1.92, 95% CI 1.33-2.80) and MRA therapy (HR 1.51, 95% CI 1.10-2.09). Income and educational level did not influence drug discontinuation rates, and similar adherence patterns were observed across all strata of socioeconomic position and multimorbidity.
In patients with CRTs, drug discontinuation rates were low, and adherence to HF pharmacotherapy was comparable regardless of socioeconomic position. Living alone and multimorbidity were associated with the discontinuation of specific HF drugs.
尽管植入了心脏再同步治疗（CRT）设备，但药物治疗仍是心力衰竭（HF）治疗的基石。本研究的目的是调查（i）药物停用与（ii）CRT植入后长期坚持HF药物治疗与社会经济地位和多种疾病之间的关联。
我们进行了一项基于登记处的队列研究，纳入了2000年至2017年在奥胡斯大学医院首次接受CRT植入的所有患者。HF药物治疗包括β受体阻滞剂（BBs）、肾素-血管紧张素系统抑制剂[血管紧张素转换酶抑制剂（ACEI）/血管紧张素II受体阻滞剂（ARB）]和盐皮质激素受体拮抗剂（MRAs）。通过丹麦起搏器和国际疾病分类登记处识别患者，并通过与丹麦健康登记处的链接获取有关药物治疗和合并症的信息。我们识别出2007例患者，其中1880例（94%）符合纳入标准。10年时BB药物停用的累积发生率为6%[95%置信区间（CI）5 - 8%]，ACEI/ARB为10%（95%CI 9 - 12%），MRAs为24%（95%CI 20 - 27%）。独居与较高的BB停药率相关[风险比（HR）1.83，95%CI 1.20 - 2.79]，而患有多种疾病的患者更有可能停用ACEI/ARB（HR 1.92，95%CI 1.33 - 2.80）和MRA治疗（HR 1.51，95%CI 1.10 - 2.09）。收入和教育水平并未影响药物停用率，在社会经济地位和多种疾病的所有分层中均观察到类似的依从模式。
在接受CRT治疗的患者中，药物停用率较低，无论社会经济地位如何，坚持HF药物治疗的情况相当。独居和多种疾病与特定HF药物的停用有关。
