背景:很少有研究根据心力衰竭的时间过程评估指南指导治疗的预后意义。这项研究分别评估了从头急性心力衰竭(AHF)和急性失代偿性慢性心力衰竭(ADCHF)患者出院时对指南指导治疗的依从性与60天临床结局之间的关系。
方法:在从韩国急性心力衰竭多中心队列登记中招募的5,625例AHF患者中,分析了2,769例射血分数降低的患者。指导治疗定义为使用血管紧张素转换酶抑制剂(ACEI)或血管紧张素受体II阻滞剂(ARB),β-受体阻滞剂,和盐皮质激素受体拮抗剂。
结果:从头AHF,ACEI或ARB减少了再次住院(危险比[HR],0.57;95%置信区间[CI],0.34-0.95),死亡率(HR,0.41;95%CI,0.24-0.69)和复合终点(HR,0.52;95%CI,0.36-0.77)率。β受体阻滞剂减少了再次住院(HR,0.62;95%CI,0.41-0.95)和复合终点(HR,0.65;95%CI,0.47-0.90)率。在ADCHF中,ACEI或ARB依从性仅与死亡率相关,β受体阻滞剂与复合终点相关.
结论:在新发生的心力衰竭中,出院时坚持指南指导治疗对预后的影响更为显著。我们建议在射血分数降低的心力衰竭过程中尽早开始指南指导的治疗。
BACKGROUND: There have been few studies to evaluate the prognostic implications of
guideline-directed therapy according to the temporal course of heart failure. This study assessed the relationship between adherence to
guideline-directed therapy at discharge and 60-day clinical outcomes in de novo acute heart failure (AHF) and acute decompensated chronic heart failure (ADCHF) separately.
METHODS: Among 5,625 AHF patients who were recruited from a multicenter cohort registry of Korean Acute Heart Failure, 2,769 patients with reduced ejection fraction were analyzed.
Guideline-directed therapies were defined as the use of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor II blocker (ARB), β-blocker, and mineralocorticoid receptor antagonist.
RESULTS: In de novo AHF, ACEI or ARB reduced re-hospitalization (hazard ratio [HR], 0.57; 95% confidence interval [CI], 0.34-0.95), mortality (HR, 0.41; 95% CI, 0.24-0.69) and composite endpoint (HR, 0.52; 95% CI, 0.36-0.77) rates. Beta-blockers reduced re-hospitalization (HR, 0.62; 95% CI, 0.41-0.95) and composite endpoint (HR, 0.65; 95% CI, 0.47-0.90) rates. In ADCHF, adherence to ACEI or ARB was associated with only mortality and β-blockers with composite endpoint.
CONCLUSIONS: The prognostic implications of adherence to
guideline-directed therapy at discharge were more pronounced in de novo heart failure. We recommend that
guideline-directed therapy be started as early as possible in the course of heart failure with reduced ejection fraction.