Hu Wei-Syun, Lin Cheng-Li
School of Medicine, College of Medicine, China Medical University, Taichung, 40402, Taiwan.
Division of Cardiovascular Medicine, Department of Medicine, China Medical University Hospital, 2, Yuh-Der Road, Taichung, 40447, Taiwan.
Naunyn Schmiedebergs Arch Pharmacol. 2025 Feb 19. doi: 10.1007/s00210-025-03855-z.
The authors report a retrospective cohort study based on a national dataset that explores the association between the prescription of three beta-blockers (BB) and a diagnosis of heart failure (HF) readmission, cardiovascular (CV) death, and all-cause death. Patients with HF who received nebivolol, carvedilol, and bisoprolol between 2016 and 2020 were identified. Univariate and multivariate Cox proportional hazard regression analyses were employed to assess and examine the crude and adjusted hazard ratio of the outcomes associated with the three BBs, demographics, comorbidities, and concomitant medications. We further performed Cox proportional hazards regression analyses for the three BBs stratified by age. A total of 109,466 BB patients including 85,166 bisoprolol patients, 19,741 carvedilol patients, 4559 nebivolol patients, and 109,466 non-BB patients were enrolled in our study. Both carvedilol and bisoprolol cohorts had a higher risk of readmission for HF than the non-BB cohort (carvedilol: adjusted HR = 1.13, 95% CI = 1.10-1.15; bisoprolol: adjusted HR = 1.17, 95% CI = 1.16-1.19). Nebivolol cohorts had a lower risk of readmission for HF than the non-BB cohort (adjusted HR = 0.78, 95% CI = 0.74-0.83). There were higher risks of CV (carvedilol: adjusted HR = 1.31, 95% CI = 1.26-1.36; bisoprolol: adjusted HR = 1.17, 95% CI = 1.14-1.2) and all-cause (carvedilol: adjusted HR = 1.26, 95% CI = 1.23-1.29; bisoprolol: adjusted HR = 1.18, 95% CI = 1.17-1.20) deaths in the carvedilol and bisoprolol cohorts in contrast to the non-BB nebivolol cohort. Nebivolol cohorts had a lower risk of CV deaths and all-cause deaths than the non-BB cohort (adjusted HR = 0.77, 95% CI = 0.69-0.85; adjusted HR = 0.78, 95% CI = 0.73-0.83). The authors concluded that the use of nebivolol was associated with better outcomes in patients with HF.
作者报告了一项基于全国数据集的回顾性队列研究，该研究探讨了三种β受体阻滞剂（BB）的处方与心力衰竭（HF）再入院、心血管（CV）死亡和全因死亡诊断之间的关联。确定了2016年至2020年间接受奈必洛尔、卡维地洛和比索洛尔治疗的HF患者。采用单因素和多因素Cox比例风险回归分析来评估和检验与三种BB、人口统计学、合并症和伴随用药相关的结局的粗风险比和调整后风险比。我们还对按年龄分层的三种BB进行了Cox比例风险回归分析。我们的研究共纳入了109466例BB患者，包括85166例比索洛尔患者、19741例卡维地洛患者、4559例奈必洛尔患者和109466例非BB患者。卡维地洛和比索洛尔队列的HF再入院风险均高于非BB队列（卡维地洛：调整后HR = 1.13，95%CI = 1.10 - 1.15；比索洛尔：调整后HR = 1.17，95%CI = 1.16 - 1.19）。奈必洛尔队列的HF再入院风险低于非BB队列（调整后HR = 0.78，95%CI = 0.74 - 0.83）。与非BB奈必洛尔队列相比，卡维地洛和比索洛尔队列的CV（卡维地洛：调整后HR = 1.31，95%CI = 1.26 - 1.36；比索洛尔：调整后HR = 1.17，95%CI = 1.14 - 1.2）和全因（卡维地洛：调整后HR = 1.26，95%CI = 1.23 - 1.29；比索洛尔：调整后HR = 1.18，95%CI = 1.17 - 1.20）死亡风险更高。奈必洛尔队列的CV死亡和全因死亡风险低于非BB队列（调整后HR = 0.77，95%CI = 0.69 - 0.85；调整后HR = 0.78，95%CI = 0.73 - 0.83）。作者得出结论，奈必洛尔的使用与HF患者更好的结局相关。
