Sundström Johan, Gustafsson Stefan, Cars Thomas, Lindholm Daniel
Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia.
Eur J Heart Fail. 2024 Nov;26(11):2443-2450. doi: 10.1002/ejhf.3426. Epub 2024 Aug 31.
In patients with heart failure, treatment patterns in the last years of life have not been assessed at large scale. We aimed to assess whether heart failure treatment patterns up to 5 years prior to death changed over time.
In a cohort study covering the whole Swedish population, we assessed all heart failure patients who died between 1 July 2007 and 31 December 2020 for evidence-based treatments. The proportion on the respective treatment at the time of death was examined by year of death using binomial regression. Looking back in time, treatment discontinuation rates were estimated using Poisson regression on time-split data. Combining these models, the proportion on each medication was estimated up to 5 years prior to death. A total of 364 480 patients died with heart failure during the study period. Half were women, and the median (interquartile range) age at death was 86 (79-90). The use of all heart failure treatments decreased gradually closer to death, but the discontinuation rate of beta blockers decreased over time, resulting in an increasing proportion of patients on treatment at the time of death.
In patients with heart failure, a changing pattern of medical treatment during the last years of life was observed, most notably with an increasing use of beta blockers. This may in part be due to a changing pattern of comorbidities over time, with an increase in e.g. hypertension and atrial fibrillation, but a decline in ischaemic heart disease.
在心力衰竭患者中，尚未大规模评估其生命最后几年的治疗模式。我们旨在评估死亡前5年内心力衰竭的治疗模式是否随时间变化。
在一项涵盖瑞典全体人口的队列研究中，我们评估了2007年7月1日至2020年12月31日期间死亡的所有心力衰竭患者的循证治疗情况。使用二项式回归，按死亡年份检查死亡时接受相应治疗的比例。回顾过去，使用时间分割数据的泊松回归估计治疗中断率。结合这些模型，估计死亡前5年内每种药物的使用比例。在研究期间，共有364480名患者死于心力衰竭。其中一半为女性，死亡时的年龄中位数（四分位间距）为86岁（79 - 90岁）。所有心力衰竭治疗的使用在接近死亡时逐渐减少，但β受体阻滞剂的停药率随时间下降，导致死亡时接受治疗的患者比例增加。
在心力衰竭患者中，观察到生命最后几年的药物治疗模式发生了变化，最显著的是β受体阻滞剂的使用增加。这可能部分归因于随着时间推移合并症模式的变化，例如高血压和心房颤动增加，而缺血性心脏病减少。
