用户,您好,欢迎您进入NSTL重点领域信息门户! 登录 | 注册  帮助中心
重点领域信息门户
您当前的位置: 首页 > [2018年第3期]情报条目详细信息

编译内容

编译服务: 心血管疾病防治 编译者: 张燕舞 编译时间: May 22, 2018 浏 览 量: 1

β受体阻滞剂治疗减少射血分数降低(HFrEF)的心力衰竭患者的症状和死亡率,但β受体阻滞剂治疗对保留射血分数(HFpEF)的心力衰竭患者的疗效尚不确定。 一项单独的患者级荟萃分析评估了β受体阻滞剂对窦性心律患者心衰的疗效。 β受体阻滞剂治疗可降低HFrEF患者的死亡率和心血管死亡率,但HFpEF患者的小部分患者没有获益,尽管置信区间很大。 如果没有其他适应症,我们建议不要使用HFpEF的β受体阻滞剂。

Aims Recent guidelines recommend that patients with heart failure and left ventricular ejection fraction (LVEF) 40-49% should be managed similar to LVEF ≥ 50%. We investigated the effect of beta-blockers according to LVEF in double-blind, randomized, placebo-controlled trials.

Methods and results Individual patient data meta-analysis of 11 trials, stratified by baseline LVEF and heart rhythm (Clinicaltrials.gov: NCT0083244; PROSPERO: CRD42014010012). Primary outcomes were all-cause mortality and cardiovascular death over 1.3 years median follow-up, with an intention-to-treat analysis. For 14 262 patients in sinus rhythm, median LVEF was 27% (interquartile range 21-33%), including 575 patients with LVEF 40-49% and 244 ≥ 50%. Beta-blockers reduced all-cause and cardiovascular mortality compared to placebo in sinus rhythm, an effect that was consistent across LVEF strata, except forthose in the small subgroup with LVEF ≥ 50%. For LVEF 40-49%, death occurred in 21/292 [7.2%]randomized to beta-blockers compared to 35/283 [12.4%]with placebo; adjusted hazard ratio (HR) 0.59 [95% confidence interval (CI) 0.34-1.03]. Cardiovascular death occurred in 13/292 [4.5%]with beta-blockers and 26/283 [9.2%]with placebo; adjusted HR 0.48 (95% CI 0.24-0.97). Over a median of 1.0 years following randomization (n = 4601), LVEF increased with beta-blockers in all groups in sinus rhythm except LVEF ≥50%. For patients in atrial fibrillation at baseline (n = 3050), beta-blockers increased LVEF when < 50% at baseline, but did not improve prognosis.

Conclusion Beta-blockers improve LVEF and prognosis for patients with heart failure in sinus rhythm with a reduced LVEF. The data are most robust for LVEF < 40%, but similar benefit was observed in the subgroup of patients with LVEF 40-49%.

  
提供服务
导出本资源