Brennan Matthew T, Harmouch Khaled M, Basit Jawad, Alraies M Chadi
Wayne State University School of Medicine, Detroit, MI.
Department of Internal Medicine, Wayne State University School of Medicine, Detroit Medical Center, Detroit, MI.
Ochsner J. 2024 Fall;24(3):198-203. doi: 10.31486/toj.24.0011.
Acute decompensated heart failure accounts for more than 1 million hospitalizations in the United States every year. Beta-blockers are a first-line agent for patients experiencing heart failure with reduced ejection fraction, but beta-blocker use in patients hospitalized for acute decompensated heart failure remains low. We conducted an analysis of the existing evidence and guidelines to determine the conditions for prescribing beta-blockers to patients with acute decompensated heart failure. We searched the PubMed database for studies from 2004 to 2024 that included the search terms "beta blockers" and "acute decompensated heart failure." We included studies in which beta-blockers were used in patients with heart failure with reduced ejection fraction and excluded studies that did not study beta-blockers directly. We compiled recommendations from professional societies regarding beta-blocker usage-both for outpatients with heart failure with reduced ejection fraction and for patients hospitalized with acute decompensated heart failure. Studies consistently demonstrated lower rates of mortality and rehospitalization when beta-blocker therapy was maintained for patients with heart failure with reduced ejection fraction who were already on beta-blocker therapy. Conversely, withdrawal of beta-blocker therapy was associated with increased in-hospital and short-term mortality. We summarized our findings in a guideline-based flowchart to help physicians make informed decisions regarding beta-blocker therapy in patients with acute decompensated heart failure. Based on the evidence, beta-blockers should be initiated at a low dose in patients with heart failure with reduced ejection fraction who have never been on beta-blockers, provided the patient is hemodynamically stable. Our research and our guideline-based flowchart promote guideline-directed use of beta-blockers to improve the outcomes of patients with heart failure with reduced ejection fraction.
在美国，急性失代偿性心力衰竭每年导致超过100万人住院治疗。β受体阻滞剂是射血分数降低的心力衰竭患者的一线用药，但在因急性失代偿性心力衰竭住院的患者中，β受体阻滞剂的使用率仍然很低。我们对现有证据和指南进行了分析，以确定给急性失代偿性心力衰竭患者开具β受体阻滞剂的条件。我们在PubMed数据库中搜索了2004年至2024年的研究，搜索词为“β受体阻滞剂”和“急性失代偿性心力衰竭”。我们纳入了在射血分数降低的心力衰竭患者中使用β受体阻滞剂的研究，并排除了未直接研究β受体阻滞剂的研究。我们汇编了专业协会关于β受体阻滞剂使用的建议——既适用于射血分数降低的心力衰竭门诊患者，也适用于因急性失代偿性心力衰竭住院的患者。研究一致表明，对于已经接受β受体阻滞剂治疗的射血分数降低的心力衰竭患者，维持β受体阻滞剂治疗可降低死亡率和再住院率。相反，停用β受体阻滞剂治疗与住院期间和短期死亡率增加有关。我们在一个基于指南的流程图中总结了我们的研究结果，以帮助医生就急性失代偿性心力衰竭患者的β受体阻滞剂治疗做出明智的决定。基于这些证据，对于从未使用过β受体阻滞剂的射血分数降低的心力衰竭患者，只要患者血流动力学稳定，就应以低剂量开始使用β受体阻滞剂。我们的研究和基于指南的流程图促进了β受体阻滞剂的指南导向使用，以改善射血分数降低的心力衰竭患者的治疗效果。
