■对于射血分数(HFrEF)和左心室射血分数(LVEF)≤35%的心力衰竭患者,使用当代指南指导的药物治疗(GDMT)或GDMT结合植入式心脏复律除颤器(ICD)/心脏再同步治疗除颤器(CRT-D)治疗的结果存在有限的现实证据。
■本研究旨在评估与GDMT或GDMT联合ICD/CRT-D治疗相关的生存率。
■这项回顾性观察研究包括了从2016年1月1日至2023年12月19日的真实世界去识别数据,这些数据来自每个参与机构协议的24个美国机构(褐煤数据库;褐煤,Inc.).包括诊断为HFrEF和超声心动图研究记录LVEF≤35%的患者进行分析。
■43,591例符合LVEF≤35%指标的患者中,处方史通过≥1年预索引,没有ICD/CRT-D治疗前指数,平均±标准差指数年龄为71.2±13.2岁;14,805例(34.0%)患者为女性。24个月时,估计99.1%(95%置信区间[CI]99.0%-99.2%),89.9%(95%CI89.7%-90.1%),54.8%(95%CI54.4%-55.2%),和17.2%(95%CI16.9%-17.5%),规定了≥1、2、3或所有4个GDMT类别,分别;估计15.7%(95%CI15.3%-16.1%)有装置放置。在那些没有设备的人中,到24个月,估计有45.1%(95%CI44.4%-45.7%)的LVEF>35%.规定的GDMT类别计数以及ICD/CRT-D设备治疗与该人群的较低死亡风险相关。即使在调整了患者年龄之后,性别,和合并症。
■两种GDMT处方和器械治疗都与较低的死亡风险独立相关,即使存在更多的GDMT选项,对于这个更现代的人口。
UNASSIGNED: Limited real-world evidence exists for outcomes with contemporary
guideline-directed medical therapy (GDMT) or GDMT with implantable cardioverter-defibrillator (ICD)/cardiac resynchronization therapy defibrillator (CRT-D) therapy for patients with heart failure with reduced ejection fraction (HFrEF) and left ventricular ejection fraction (LVEF) ≤35%.
UNASSIGNED: The present study aimed to assess survival associated with GDMT or GDMT with ICD/CRT-D therapy.
UNASSIGNED: This retrospective observational study included real-world de-identified data from January 1, 2016, to December 19, 2023, from 24 U.S. institutions per participating institutional agreements (egnite Database; egnite, Inc.). Patients with a diagnosis of HFrEF and an echocardiographic study documenting LVEF ≤35% were included for analysis.
UNASSIGNED: Of 43,591 patients with eligible index event of LVEF ≤35%, prescription history through ≥1 year preindex, and no ICD/CRT-D therapy preindex, mean ± standard deviation age at index was 71.2 ± 13.2 years; 14,805 (34.0%) patients were female. At 24 months, an estimated 99.1% (95% confidence interval [CI] 99.0%-99.2%), 89.9% (95% CI 89.7%-90.1%), 54.8% (95% CI 54.4%-55.2%), and 17.2% (95% CI 16.9%-17.5%), had ≥1, 2, 3, or all 4 GDMT classes prescribed, respectively; an estimated 15.7% (95% CI 15.3%-16.1%) had device placement. Of those without a device, by 24 months, an estimated 45.1% (95% CI 44.4%-45.7%) had a documented LVEF >35%. Counts of GDMT classes prescribed as well as ICD/CRT-D device therapy were associated with lower mortality risk in this population, even after adjustment for patient age, sex, and comorbidities.
UNASSIGNED: Both GDMT classes prescribed and device therapy were independently associated with lower mortality risk, even in the presence of more GDMT options for this more contemporary population.