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JAHA:这类心衰患者入院使用 β 受体阻滞剂,可降低58%的院内死亡风险

2021-07-06 “心关注”公众号 “心关注”公众号

日本京都大学医学院学者近期发表在美国心脏协会杂志《JAHA》上的文章,分析了急性失代偿性心力衰竭患者入院时使用β受体阻滞剂与否,和患者预后生存的相关性。

日本京都大学医学院学者近期发表在美国心脏协会杂志《JAHA》上的文章,分析了急性失代偿性心力衰竭患者入院时使用β受体阻滞剂与否,和患者预后生存的相关性。

01

β受体阻滞剂使用情况

研究最终纳入了当地3817例急性失代偿性心力衰竭患者,包括1512(39.7%)例入院时接受β受体阻滞剂治疗的患者(β组),以及2305(60.3%)例未接受患者(非β组)。其中,接受卡维地洛、比索洛尔、阿替洛尔、美托洛尔治疗的患者,分别有888、507、35、34例。

图1:接受不同β受体阻滞剂治疗的患者比例及日剂量

当将其他β受体阻滞剂均转换为卡维地洛剂量时,有774例患者接受低剂量β受体阻滞剂治疗,680例患者接受高剂量。

图2:服用不同剂量卡维地洛的患者人数统计

另外,β组共1445例患者存活出院,89.2%的患者出院继续服用β受体阻滞剂;非β组共2130例患者存活出院,49.6%的患者出院服用β受体阻滞剂。

02

入院使用β受体阻滞剂与否的相关因素

在分析了20个患者基线特征和临床相关变量后,发现:

与入院使用β受体阻滞剂独立相关的因素有:

既往心衰入院史,室性快速型心律失常病史,心肌梗死史,房颤史,匹莫苯使用史,ACEI或ARB使用史,心肌病,盐皮质激素受体拮抗剂使用史,eGFR <30 mL/min per 1.73 ㎡。

与入院不使用β受体阻滞剂独立相关的因素有:

哮喘、慢阻肺、低BMI、痴呆,老龄,LVEF<40%。

03

在院死亡率

在院死亡率方面,β组与非β组患者的全因死亡率、心血管死亡率、非心血管死亡率对比分别为4.4% vs. 7.6%、3.4% vs. 5.4%、1.1% vs .2.2%,β组均更低,对应的死亡风险分别降低58%、59%、51。

其中,β组与非β组患者的心源性猝死发生率分别为0.2% 、0.43%,无显着差异。

图3:β组与非β组患者的各类死亡例数及比例

另外,在非心血管死亡的具体原因中,包括感染、呼吸衰竭、恶性肿瘤、胃肠道出血等,两组仅在感染死亡率上存在显着差异,β组更低。

04

β受体阻滞剂剂量与在院死亡率

相比非β组患者,接受低剂量、高剂量β受体阻滞剂的患者,在院死亡风险分别降低57%、65%。

图4:β受体阻滞剂剂量与在院死亡率及风险对比

05

有无循证依据的β受体阻滞剂

在日本,卡维地洛和比索洛尔有循证医学依据,对比其他品类无循证支持(日本)的β受体阻滞剂,在院死亡率方面并无显着差异。

06

术后亚组分析

从术后亚组分析结果可见,对于存在心衰住院史的患者,在降低在院死亡风险上,使用β受体阻滞剂的效果更为显着,存在交互作用。而其他亚组变量,与β受体阻滞剂对在院死亡率的影响上,并无交互作用。

图5:亚组分析

日本学者的这项近4千人研究认为,急性失代偿心衰患者入院使用 β 受体阻滞剂,有助于降低在院死亡率。

原始出处:

Yodo Tamaki, et al. Lower In-Hospital Mortality With BetaBlocker Use at Admission in Patients With Acute Decompensated Heart Failure. JAHA. Originally published26 Jun 2021.

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    2021-11-02 小不忍则

    是入院时还在使用吧,并不是入院后使用

    0

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    2021-12-30 zhyy88
  4. [GetPortalCommentsPageByObjectIdResponse(id=1635254, encodeId=527b1635254ca, content=<a href='/topic/show?id=bb41983049e' target=_blank style='color:#2F92EE;'>#院内死亡#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98304, encryptionId=bb41983049e, topicName=院内死亡)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=78f122436081, createdName=yuhaisheng_ibp_32061718, createdTime=Tue Dec 07 08:51:18 CST 2021, time=2021-12-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1066128, encodeId=361d106612802, content=是入院时还在使用吧,并不是入院后使用, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/10/31/c5cd65bc1b2b43a9370a16b370993572.jpg, createdBy=baa92155751, createdName=小不忍则, createdTime=Tue Nov 02 09:14:31 CST 2021, time=2021-11-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2085858, encodeId=79b32085858f2, content=<a href='/topic/show?id=723a9e69383' target=_blank style='color:#2F92EE;'>#阻滞剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97693, encryptionId=723a9e69383, topicName=阻滞剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=40be178, createdName=zhyy88, createdTime=Thu Dec 30 22:51:18 CST 2021, time=2021-12-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1995223, encodeId=f5a6199522326, content=<a href='/topic/show?id=347538040cf' target=_blank style='color:#2F92EE;'>#受体阻滞剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=38040, encryptionId=347538040cf, topicName=受体阻滞剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=54f9127, createdName=tulenzi, createdTime=Mon Sep 20 09:51:18 CST 2021, time=2021-09-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1256105, encodeId=93761256105d8, content=<a href='/topic/show?id=587f6339050' target=_blank style='color:#2F92EE;'>#死亡风险#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63390, encryptionId=587f6339050, topicName=死亡风险)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=74808, createdName=quxin068, createdTime=Thu Jul 08 09:51:18 CST 2021, time=2021-07-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1268577, encodeId=a67012685e799, content=<a href='/topic/show?id=922f21183d' target=_blank style='color:#2F92EE;'>#AHA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2118, encryptionId=922f21183d, topicName=AHA)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bf3d82, createdName=zhaohui6731, createdTime=Thu Jul 08 09:51:18 CST 2021, time=2021-07-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1373533, encodeId=c7f613e35337e, content=<a href='/topic/show?id=2fd051939ab' target=_blank style='color:#2F92EE;'>#心衰患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51939, encryptionId=2fd051939ab, topicName=心衰患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=467c360, createdName=yuanming7, createdTime=Thu Jul 08 09:51:18 CST 2021, time=2021-07-08, status=1, ipAttribution=)]
  5. [GetPortalCommentsPageByObjectIdResponse(id=1635254, encodeId=527b1635254ca, content=<a href='/topic/show?id=bb41983049e' target=_blank style='color:#2F92EE;'>#院内死亡#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98304, encryptionId=bb41983049e, topicName=院内死亡)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=78f122436081, createdName=yuhaisheng_ibp_32061718, createdTime=Tue Dec 07 08:51:18 CST 2021, time=2021-12-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1066128, encodeId=361d106612802, content=是入院时还在使用吧,并不是入院后使用, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/10/31/c5cd65bc1b2b43a9370a16b370993572.jpg, createdBy=baa92155751, createdName=小不忍则, createdTime=Tue Nov 02 09:14:31 CST 2021, time=2021-11-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2085858, encodeId=79b32085858f2, content=<a href='/topic/show?id=723a9e69383' target=_blank style='color:#2F92EE;'>#阻滞剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97693, encryptionId=723a9e69383, topicName=阻滞剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=40be178, createdName=zhyy88, createdTime=Thu Dec 30 22:51:18 CST 2021, time=2021-12-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1995223, encodeId=f5a6199522326, content=<a href='/topic/show?id=347538040cf' target=_blank style='color:#2F92EE;'>#受体阻滞剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=38040, encryptionId=347538040cf, topicName=受体阻滞剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=54f9127, createdName=tulenzi, createdTime=Mon Sep 20 09:51:18 CST 2021, time=2021-09-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1256105, encodeId=93761256105d8, content=<a href='/topic/show?id=587f6339050' target=_blank style='color:#2F92EE;'>#死亡风险#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63390, encryptionId=587f6339050, topicName=死亡风险)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=74808, createdName=quxin068, createdTime=Thu Jul 08 09:51:18 CST 2021, time=2021-07-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1268577, encodeId=a67012685e799, content=<a href='/topic/show?id=922f21183d' target=_blank style='color:#2F92EE;'>#AHA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2118, encryptionId=922f21183d, topicName=AHA)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bf3d82, createdName=zhaohui6731, createdTime=Thu Jul 08 09:51:18 CST 2021, time=2021-07-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1373533, encodeId=c7f613e35337e, content=<a href='/topic/show?id=2fd051939ab' target=_blank style='color:#2F92EE;'>#心衰患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51939, encryptionId=2fd051939ab, topicName=心衰患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=467c360, createdName=yuanming7, createdTime=Thu Jul 08 09:51:18 CST 2021, time=2021-07-08, status=1, ipAttribution=)]
  6. [GetPortalCommentsPageByObjectIdResponse(id=1635254, encodeId=527b1635254ca, content=<a href='/topic/show?id=bb41983049e' target=_blank style='color:#2F92EE;'>#院内死亡#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98304, encryptionId=bb41983049e, topicName=院内死亡)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=78f122436081, createdName=yuhaisheng_ibp_32061718, createdTime=Tue Dec 07 08:51:18 CST 2021, time=2021-12-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1066128, encodeId=361d106612802, content=是入院时还在使用吧,并不是入院后使用, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/10/31/c5cd65bc1b2b43a9370a16b370993572.jpg, createdBy=baa92155751, createdName=小不忍则, createdTime=Tue Nov 02 09:14:31 CST 2021, time=2021-11-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2085858, encodeId=79b32085858f2, content=<a href='/topic/show?id=723a9e69383' target=_blank style='color:#2F92EE;'>#阻滞剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97693, encryptionId=723a9e69383, topicName=阻滞剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=40be178, createdName=zhyy88, createdTime=Thu Dec 30 22:51:18 CST 2021, time=2021-12-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1995223, encodeId=f5a6199522326, content=<a href='/topic/show?id=347538040cf' target=_blank style='color:#2F92EE;'>#受体阻滞剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=38040, encryptionId=347538040cf, topicName=受体阻滞剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=54f9127, createdName=tulenzi, createdTime=Mon Sep 20 09:51:18 CST 2021, time=2021-09-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1256105, encodeId=93761256105d8, content=<a href='/topic/show?id=587f6339050' target=_blank style='color:#2F92EE;'>#死亡风险#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63390, encryptionId=587f6339050, topicName=死亡风险)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=74808, createdName=quxin068, createdTime=Thu Jul 08 09:51:18 CST 2021, time=2021-07-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1268577, encodeId=a67012685e799, content=<a href='/topic/show?id=922f21183d' target=_blank style='color:#2F92EE;'>#AHA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2118, encryptionId=922f21183d, topicName=AHA)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bf3d82, createdName=zhaohui6731, createdTime=Thu Jul 08 09:51:18 CST 2021, time=2021-07-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1373533, encodeId=c7f613e35337e, content=<a href='/topic/show?id=2fd051939ab' target=_blank style='color:#2F92EE;'>#心衰患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51939, encryptionId=2fd051939ab, topicName=心衰患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=467c360, createdName=yuanming7, createdTime=Thu Jul 08 09:51:18 CST 2021, time=2021-07-08, status=1, ipAttribution=)]
    2021-07-08 zhaohui6731
  7. [GetPortalCommentsPageByObjectIdResponse(id=1635254, encodeId=527b1635254ca, content=<a href='/topic/show?id=bb41983049e' target=_blank style='color:#2F92EE;'>#院内死亡#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=98304, encryptionId=bb41983049e, topicName=院内死亡)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=78f122436081, createdName=yuhaisheng_ibp_32061718, createdTime=Tue Dec 07 08:51:18 CST 2021, time=2021-12-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1066128, encodeId=361d106612802, content=是入院时还在使用吧,并不是入院后使用, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/10/31/c5cd65bc1b2b43a9370a16b370993572.jpg, createdBy=baa92155751, createdName=小不忍则, createdTime=Tue Nov 02 09:14:31 CST 2021, time=2021-11-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2085858, encodeId=79b32085858f2, content=<a href='/topic/show?id=723a9e69383' target=_blank style='color:#2F92EE;'>#阻滞剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97693, encryptionId=723a9e69383, topicName=阻滞剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=40be178, createdName=zhyy88, createdTime=Thu Dec 30 22:51:18 CST 2021, time=2021-12-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1995223, encodeId=f5a6199522326, content=<a href='/topic/show?id=347538040cf' target=_blank style='color:#2F92EE;'>#受体阻滞剂#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=38040, encryptionId=347538040cf, topicName=受体阻滞剂)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=54f9127, createdName=tulenzi, createdTime=Mon Sep 20 09:51:18 CST 2021, time=2021-09-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1256105, encodeId=93761256105d8, content=<a href='/topic/show?id=587f6339050' target=_blank style='color:#2F92EE;'>#死亡风险#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63390, encryptionId=587f6339050, topicName=死亡风险)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=74808, createdName=quxin068, createdTime=Thu Jul 08 09:51:18 CST 2021, time=2021-07-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1268577, encodeId=a67012685e799, content=<a href='/topic/show?id=922f21183d' target=_blank style='color:#2F92EE;'>#AHA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2118, encryptionId=922f21183d, topicName=AHA)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bf3d82, createdName=zhaohui6731, createdTime=Thu Jul 08 09:51:18 CST 2021, time=2021-07-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1373533, encodeId=c7f613e35337e, content=<a href='/topic/show?id=2fd051939ab' target=_blank style='color:#2F92EE;'>#心衰患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51939, encryptionId=2fd051939ab, topicName=心衰患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=467c360, createdName=yuanming7, createdTime=Thu Jul 08 09:51:18 CST 2021, time=2021-07-08, status=1, ipAttribution=)]
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