目的:本研究旨在比较包括血管紧张素受体-脑啡肽抑制剂(ARNI)和钠-葡萄糖协同转运蛋白2抑制剂(SGLT2i)在内的现代治疗方法与现实世界中常规心力衰竭治疗的有效性。
背景:由于ARNI和SGLT2i被用于治疗心力衰竭(HF),其治疗方案从以前的β-受体阻滞剂(BB)和血管紧张素转换酶抑制剂(ACEi)/血管紧张素II受体阻滞剂(ARB)和盐皮质激素受体拮抗剂(MRA)的治疗基础上进行了现代化改造,如在射血分数降低(HFrEF)的HF中加用.然而,常规治疗策略和现代治疗策略联合用药的比较尚未进行.
方法:本观察性研究(2013-2020年),使用瑞典HF注册表,涉及20,849例HF患者。患者接受了常规(BB,ACEi/ARB,有/没有MRA,n=20,140)或现代(BB,ACEi/ARB,MRA,SGLT2i或BB,阿尼,带/不带SGLT2i的MRA,n=709)在索引访问时进行治疗。终点是全因和心血管(CV)死亡率。
结果:现代HF治疗与全因死亡率显着降低28%相关(校正HR[aHR],0.72(0.54-0.96);p=0.024)和心血管死亡率显着降低62%(aHR,与常规HF治疗相比,为0.38(0.21-0.68);p=0.0013)。在使用倾向得分匹配的敏感性分析中出现了类似的结果。交互作用分析没有显示EF的任何趋势(<40%和≥40%),性别,年龄(<70岁和≥70岁),eGFR(<60和≥60ml/min/1.73m2),和HF亚组的病因。
结论:在这项全国性的研究中,现代HF治疗可显著降低全因死亡率和CV死亡率,不管EF,性别,年龄,eGFR,和HF的病因。
OBJECTIVE: This study is aimed to compare the effectiveness of modern therapy including angiotensin receptor-neprilysin inhibitor (ARNI) and sodium-glucose cotransporter 2 inhibitors (SGLT2i) with conventional heart failure treatment in the real world.
BACKGROUND: Since ARNI and SGLT2i were introduced to treat heart failure (HF), its therapeutic regimen has modernized from previous treatment with beta-blocker (BB) and angiotensin-converting enzyme inhibitor (ACEi)/angiotensin II receptor blocker (ARB) with mineralocorticoid receptor antagonist (MRA) as added-on in HF with reduced ejection fraction (HFrEF). However, a comparison between conventional and modern treatment strategies with drugs in combination has not been performed.
METHODS: This observational study (2013-2020), using the Swedish HF Registry, involved 20,849 HF patients. Patients received either conventional (BB, ACEi/ARB, with/without MRA, n = 20,140) or modern (BB, ACEi/ARB, MRA, SGLT2i or BB, ARNI, MRA with/without SGLT2i, n = 709) treatment at the index visit. The endpoints were all-cause and cardiovascular (CV) mortality.
RESULTS: Modern HF therapy was associated with a significant 28% reduction in all-cause mortality (adjusted HR [aHR], 0.72 (0.54-0.96); p = 0.024) and a significant 62% reduction in CV mortality (aHR, 0.38 (0.21-0.68); p = 0.0013) compared to conventional HF treatment. Similar results emerged in a sensitivity analysis using propensity score matching. The interaction analyses did not reveal any trends for EF (< 40% and ≥ 40%), sex, age (< 70 and ≥ 70 years), eGFR (< 60 and ≥ 60 ml/min/1.73 m2), and etiology of HF subgroups.
CONCLUSIONS: In this nationwide study, modern HF therapy was associated with significantly reduced all-cause and CV mortality, regardless of EF, sex, age, eGFR, and etiology of HF.