Heidenreich P A, Lee T T, Massie B M
Department of Health Research and Policy, Stanford University, California, USA.
J Am Coll Cardiol. 1997 Jul;30(1):27-34. doi: 10.1016/s0735-1097(97)00104-6.
We sought to evaluate the current evidence for an effect of beta-blockade treatment on mortality in patients with congestive heart failure (CHF).
Although numerous small studies have suggested a benefit with beta-blocker therapy in patients with heart failure, a clear survival benefit has not been demonstrated. A recent combined analysis of several studies with the alpha- and beta-adrenergic blocking agent carvedilol demonstrated a significant survival advantage; however, the total number of events was small. Furthermore, it is unclear if previous studies with other beta-blockers are consistent with this finding.
Randomized clinical trials of beta-blockade treatment in patients with CHF from January 1975 through February 1997 were identified using a MEDLINE search and a review of reports from scientific meetings. Studies were included if mortality was reported during 3 or more months of follow-up.
We identified 35 reports, 17 of which met the inclusion criteria. These studies included 3,039 patients with follow-up ranging from 3 months to 2 years. Beta-blockade was associated with a trend toward mortality reduction in 13 studies. When all 17 reports were combined, beta-blockade significantly reduced all-cause mortality (random effect odds ratio [OR] 0.69, 95% confidence interval [CI] 0.54 to 0.88). A trend toward greater treatment effect was noted for nonsudden cardiac death (OR 0.58, 95% CI 0.40 to 0.83) compared with sudden cardiac death (OR 0.84, 95% CI 0.59 to 1.2). Similar reductions in mortality were observed for patients with ischemic (OR 0.69, 95% CI 0.49 to 0.98) and nonischemic cardiomyopathy (OR 0.69, 95% CI 0.47 to 0.99). The survival benefit was greater for trials of the drug carvedilol (OR 0.54, 95% CI 0.36 to 0.81) than for noncarvedilol drugs (OR 0.82, 95% CI 0.60 to 1.12); however, the difference did not reach statistical significance (p = 0.10).
Pooled evidence suggests that beta-blockade reduces all-cause mortality in patients with CHF. Additional trials are required to determine whether carvedilol differs in its effect from other agents.
我们试图评估β受体阻滞剂治疗对充血性心力衰竭（CHF）患者死亡率影响的现有证据。
尽管众多小型研究提示β受体阻滞剂治疗对心力衰竭患者有益，但尚未证实其具有明确的生存获益。最近一项对多项使用α和β肾上腺素能阻滞剂卡维地洛的研究进行的综合分析显示出显著的生存优势；然而，事件总数较少。此外，尚不清楚之前使用其他β受体阻滞剂的研究是否与这一发现一致。
通过检索MEDLINE以及回顾科学会议报告，确定1975年1月至1997年2月期间CHF患者β受体阻滞剂治疗的随机临床试验。如果报告了3个月或更长时间随访期间的死亡率，则纳入研究。
我们确定了35份报告，其中17份符合纳入标准。这些研究包括3039例患者，随访时间为3个月至2年。13项研究中β受体阻滞剂与死亡率降低趋势相关。当合并所有17份报告时，β受体阻滞剂显著降低全因死亡率（随机效应比值比[OR]0.69，95%置信区间[CI]0.54至0.88）。与心源性猝死（OR 0.84，95%CI 0.59至1.2）相比，非心源性猝死的治疗效果有更大的降低趋势（OR 0.58，95%CI 0.40至0.83）。缺血性心肌病（OR 0.69，95%CI 0.49至0.98）和非缺血性心肌病（OR 0.69，95%CI 0.47至0.99）患者的死亡率也有类似降低。卡维地洛试验的生存获益（OR 0.54，95%CI 0.36至0.81）大于非卡维地洛药物（OR 0.82，95%CI 0.60至1.12）；然而，差异未达到统计学意义（p = 0.10）。
汇总证据表明β受体阻滞剂可降低CHF患者的全因死亡率。需要更多试验来确定卡维地洛与其他药物在疗效上是否存在差异。
