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Abstract：
Heart failure with mildly reduced ejection fraction (HFmrEF) has received increasing attention following the publication of the latest ESC guidelines in 2021. However, it remains unclear whether patients with HFmrEF could benefit from guideline-directed medical treatment (GDMT), referring the combination of ACEI/ARB/ARNI, β-blockers, and MRAs, which are recommended for those with reduced ejection fraction. This study explored the efficacy of GDMT in HFmrEF patients.
This was a retrospective cohort study of HFmrEF patients admitted to The First Affiliated Hospital of Dalian Medical University between 1 September 2015 and 30 November 2019. Propensity score matching (1:2) between patients receiving triple-drug therapy (TT) and non-triple therapy (NTT) based on age and sex was performed. The primary outcome was all cause death, cardiac death, rehospitalization from any cause, and rehospitalization due to worsening heart failure.
Of the 906 patients enrolled in the matched cohort (TT group, n = 302; NTT group, N = 604), 653 (72.08%) were male, and mean age was 61.1 ± 11.92. Survival analysis suggested that TT group experienced a significantly lower incidence of prespecified primary endpoints than NTT group. Multivariable Cox regression showed that TT group had a lower risk of all-cause mortality (HR 0.656, 95% CI 0.447-0.961, P = 0.030), cardiac death (HR 0.599, 95% CI 0.380-0.946, P = 0.028), any-cause rehospitalization (HR 0.687, 95% CI 0.541-0.872, P = 0.002), and heart failure rehospitalization (HR 0.732, 95% CI 0.565-0.948, P = 0.018).
In patients with HFmrEF, combined use of neurohormonal antagonists produces remarkable effects in reducing the occurrence of the primary outcome of rehospitalization and death. Thus, the treatment of HFmrEF should be categorized as HFrEF due to the similar benefit of neurohormonal blocking therapy in HFrEF and HFmrEF.
This was a retrospective cohort study of HFmrEF patients admitted to The First Affiliated Hospital of Dalian Medical University between 1 September 2015 and 30 November 2019. Propensity score matching (1:2) between patients receiving triple-drug therapy (TT) and non-triple therapy (NTT) based on age and sex was performed. The primary outcome was all cause death, cardiac death, rehospitalization from any cause, and rehospitalization due to worsening heart failure.
Of the 906 patients enrolled in the matched cohort (TT group, n = 302; NTT group, N = 604), 653 (72.08%) were male, and mean age was 61.1 ± 11.92. Survival analysis suggested that TT group experienced a significantly lower incidence of prespecified primary endpoints than NTT group. Multivariable Cox regression showed that TT group had a lower risk of all-cause mortality (HR 0.656, 95% CI 0.447-0.961, P = 0.030), cardiac death (HR 0.599, 95% CI 0.380-0.946, P = 0.028), any-cause rehospitalization (HR 0.687, 95% CI 0.541-0.872, P = 0.002), and heart failure rehospitalization (HR 0.732, 95% CI 0.565-0.948, P = 0.018).
In patients with HFmrEF, combined use of neurohormonal antagonists produces remarkable effects in reducing the occurrence of the primary outcome of rehospitalization and death. Thus, the treatment of HFmrEF should be categorized as HFrEF due to the similar benefit of neurohormonal blocking therapy in HFrEF and HFmrEF.
摘要：
目的：随着2021年最新的ESC指南的发布，射血分数轻度降低的心力衰竭（HFmrEF）受到了越来越多的关注。然而,目前尚不清楚HFmrEF患者是否可以从指南指导的药物治疗（GDMT）中获益，参考ACEI/ARB/ARNI的组合，β-受体阻滞剂,和MRA,这是建议那些降低射血分数。本研究探讨GDMT在HFmrEF患者中的疗效。
方法：这是2015年9月1日至2019年11月30日大连医科大学附属第一医院收治的HFmrEF患者的回顾性队列研究。根据年龄和性别，在接受三联药物治疗（TT）和非三联药物治疗（NTT）的患者之间进行倾向评分匹配（1：2）。主要结果是全因死亡，心脏死亡,任何原因再次住院，以及因心力衰竭恶化而再次住院。
结果：在匹配队列中招募的906名患者中（TT组，n=302；NTT组，N=604),653（72.08%）为男性，平均年龄为61.1±11.92。生存分析表明，TT组的预设主要终点发生率明显低于NTT组。多变量Cox回归显示TT组全因死亡风险较低(HR0.656,95%CI0.447-0.961,P=0.030)。心源性死亡（HR0.599，95%CI0.380-0.946，P=0.028），任何原因再住院（HR0.687，95%CI0.541-0.872，P=0.002），和心力衰竭再住院（HR0.732，95％CI0.565-0.948，P=0.018）。
结论：在HFmrEF患者中，联合使用神经激素拮抗剂在减少再住院和死亡的主要结局的发生方面产生显著效果.因此，由于神经激素阻断治疗对HFrEF和HFmrEF的益处相似,因此HFmrEF的治疗应归类为HFrEF.
方法：这是2015年9月1日至2019年11月30日大连医科大学附属第一医院收治的HFmrEF患者的回顾性队列研究。根据年龄和性别，在接受三联药物治疗（TT）和非三联药物治疗（NTT）的患者之间进行倾向评分匹配（1：2）。主要结果是全因死亡，心脏死亡,任何原因再次住院，以及因心力衰竭恶化而再次住院。
结果：在匹配队列中招募的906名患者中（TT组，n=302；NTT组，N=604),653（72.08%）为男性，平均年龄为61.1±11.92。生存分析表明，TT组的预设主要终点发生率明显低于NTT组。多变量Cox回归显示TT组全因死亡风险较低(HR0.656,95%CI0.447-0.961,P=0.030)。心源性死亡（HR0.599，95%CI0.380-0.946，P=0.028），任何原因再住院（HR0.687，95%CI0.541-0.872，P=0.002），和心力衰竭再住院（HR0.732，95％CI0.565-0.948，P=0.018）。
结论：在HFmrEF患者中，联合使用神经激素拮抗剂在减少再住院和死亡的主要结局的发生方面产生显著效果.因此，由于神经激素阻断治疗对HFrEF和HFmrEF的益处相似,因此HFmrEF的治疗应归类为HFrEF.
