EUR HEART J:心脏衰竭患者的药物剂量和临床结局之间的关系

2017-06-25 MedSci MedSci原创

尽管有明确的指导建议,但大多数心衰和射血分数降低的(HFrEF)患者没有达到指导原则推荐的治疗剂量。本研究探究HFrEF患者未达到指导原则推荐的治疗剂量(血管紧张素转化酶(ACE)抑制剂、血管紧张素受体阻断剂(ARB)和/或β受体阻滞剂)所引起临床结局特征和治疗指征的偏差。

背景:
尽管有明确的指导建议,但大多数心衰和射血分数降低的(HFrEF)患者没有达到指导原则推荐的治疗剂量。

目的:
探究HFrEF患者未达到指导原则推荐的治疗剂量(血管紧张素转化酶(ACE)抑制剂、血管紧张素受体阻断剂(ARB)和/或β受体阻滞剂)所引起临床结局特征和治疗指征的偏差。

方法:
此研究共招募了来自于11个欧洲国家69个中心的2516名心衰患者,他们之前未达最佳标准地治疗,并鼓励他们进行治疗。本研究中充血性心力衰竭的生物抑制剂专门用于研究血管紧张素转化酶(ACE)抑制剂、血管紧张素受体阻断剂(ARB)和/或β受体阻滞剂剂量的疗效。

结果:
151名患者在研究期间死亡,242名左心室射血分数>40%的患者被排除。平均随访时间为21个月。共研究了2100 HFrEF患者(男性:76%;平均年龄:68±12),其中22%患者达到推荐的ACE-抑制剂/ARB的治疗剂量;12%患者达到了β受体阻滞剂的治疗剂量。在欧洲国家之间有显着的差异。达到< 50%的推荐药物剂量(ACE-抑制剂/血管紧张素受体阻断剂(ARB)和β受体阻滞剂)的患者与死亡风险或心衰住院治疗增加有关。

达到≥100%的剂量的患者与达到50 - 99%的推荐剂量的患者(ACE-抑制剂/ARB和/或β受体阻滞剂)有相当的死亡风险和/或心力衰竭住院率。由于症状、副作用和非心脏器官功能障碍,未能达到推荐剂量的患者死亡率最高(ACE -抑制剂/ ARB:HR 为1.72;95% CI 为1.43 - 2.01;β-受体阻滞剂:HR为 1.70;95% CI为 1.36 - 2.05)。

结论:
与达到≥100%的推荐剂量的HFrEF患者相比,不到50%的推荐剂量(ACE-抑制剂/ ARB和β受体阻滞剂)的患者的死亡和/或心力衰竭住院的风险似乎更大。

原始出处

本文系梅斯医学(MedSci)原创编译整理,转载需授权!

版权声明:
本网站所有内容来源注明为“梅斯医学”或“MedSci原创”的文字、图片和音视频资料,版权均属于梅斯医学所有。非经授权,任何媒体、网站或个人不得转载,授权转载时须注明来源为“梅斯医学”。其它来源的文章系转载文章,或“梅斯号”自媒体发布的文章,仅系出于传递更多信息之目的,本站仅负责审核内容合规,其内容不代表本站立场,本站不负责内容的准确性和版权。如果存在侵权、或不希望被转载的媒体或个人可与我们联系,我们将立即进行删除处理。
在此留言
评论区 (5)
#插入话题
  1. [GetPortalCommentsPageByObjectIdResponse(id=1843117, encodeId=d6cc184311eb9, content=<a href='/topic/show?id=3d052296e4e' target=_blank style='color:#2F92EE;'>#临床结局#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22967, encryptionId=3d052296e4e, topicName=临床结局)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7fbd46, createdName=mei531, createdTime=Mon Sep 11 05:41:00 CST 2017, time=2017-09-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1945094, encodeId=166219450942b, content=<a href='/topic/show?id=19068e690ab' target=_blank style='color:#2F92EE;'>#药物剂量#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=87690, encryptionId=19068e690ab, topicName=药物剂量)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=263b421, createdName=zhaozuguo, createdTime=Sat Aug 19 16:41:00 CST 2017, time=2017-08-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1356364, encodeId=dad31356364f9, content=<a href='/topic/show?id=b0702e84b9' target=_blank style='color:#2F92EE;'>#ART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2784, encryptionId=b0702e84b9, topicName=ART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Tue Jun 27 12:41:00 CST 2017, time=2017-06-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1438703, encodeId=13031438e03f1, content=<a href='/topic/show?id=5c6b516e1dd' target=_blank style='color:#2F92EE;'>#心脏衰竭#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51671, encryptionId=5c6b516e1dd, topicName=心脏衰竭)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Tue Jun 27 12:41:00 CST 2017, time=2017-06-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1562592, encodeId=b8571562592cf, content=<a href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=19, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80d715270048, createdName=slcumt, createdTime=Tue Jun 27 12:41:00 CST 2017, time=2017-06-27, status=1, ipAttribution=)]
  2. [GetPortalCommentsPageByObjectIdResponse(id=1843117, encodeId=d6cc184311eb9, content=<a href='/topic/show?id=3d052296e4e' target=_blank style='color:#2F92EE;'>#临床结局#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22967, encryptionId=3d052296e4e, topicName=临床结局)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7fbd46, createdName=mei531, createdTime=Mon Sep 11 05:41:00 CST 2017, time=2017-09-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1945094, encodeId=166219450942b, content=<a href='/topic/show?id=19068e690ab' target=_blank style='color:#2F92EE;'>#药物剂量#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=87690, encryptionId=19068e690ab, topicName=药物剂量)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=263b421, createdName=zhaozuguo, createdTime=Sat Aug 19 16:41:00 CST 2017, time=2017-08-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1356364, encodeId=dad31356364f9, content=<a href='/topic/show?id=b0702e84b9' target=_blank style='color:#2F92EE;'>#ART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2784, encryptionId=b0702e84b9, topicName=ART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Tue Jun 27 12:41:00 CST 2017, time=2017-06-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1438703, encodeId=13031438e03f1, content=<a href='/topic/show?id=5c6b516e1dd' target=_blank style='color:#2F92EE;'>#心脏衰竭#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51671, encryptionId=5c6b516e1dd, topicName=心脏衰竭)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Tue Jun 27 12:41:00 CST 2017, time=2017-06-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1562592, encodeId=b8571562592cf, content=<a href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=19, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80d715270048, createdName=slcumt, createdTime=Tue Jun 27 12:41:00 CST 2017, time=2017-06-27, status=1, ipAttribution=)]
  3. [GetPortalCommentsPageByObjectIdResponse(id=1843117, encodeId=d6cc184311eb9, content=<a href='/topic/show?id=3d052296e4e' target=_blank style='color:#2F92EE;'>#临床结局#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22967, encryptionId=3d052296e4e, topicName=临床结局)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7fbd46, createdName=mei531, createdTime=Mon Sep 11 05:41:00 CST 2017, time=2017-09-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1945094, encodeId=166219450942b, content=<a href='/topic/show?id=19068e690ab' target=_blank style='color:#2F92EE;'>#药物剂量#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=87690, encryptionId=19068e690ab, topicName=药物剂量)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=263b421, createdName=zhaozuguo, createdTime=Sat Aug 19 16:41:00 CST 2017, time=2017-08-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1356364, encodeId=dad31356364f9, content=<a href='/topic/show?id=b0702e84b9' target=_blank style='color:#2F92EE;'>#ART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2784, encryptionId=b0702e84b9, topicName=ART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Tue Jun 27 12:41:00 CST 2017, time=2017-06-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1438703, encodeId=13031438e03f1, content=<a href='/topic/show?id=5c6b516e1dd' target=_blank style='color:#2F92EE;'>#心脏衰竭#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51671, encryptionId=5c6b516e1dd, topicName=心脏衰竭)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Tue Jun 27 12:41:00 CST 2017, time=2017-06-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1562592, encodeId=b8571562592cf, content=<a href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=19, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80d715270048, createdName=slcumt, createdTime=Tue Jun 27 12:41:00 CST 2017, time=2017-06-27, status=1, ipAttribution=)]
    2017-06-27 zhaojie88
  4. [GetPortalCommentsPageByObjectIdResponse(id=1843117, encodeId=d6cc184311eb9, content=<a href='/topic/show?id=3d052296e4e' target=_blank style='color:#2F92EE;'>#临床结局#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22967, encryptionId=3d052296e4e, topicName=临床结局)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7fbd46, createdName=mei531, createdTime=Mon Sep 11 05:41:00 CST 2017, time=2017-09-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1945094, encodeId=166219450942b, content=<a href='/topic/show?id=19068e690ab' target=_blank style='color:#2F92EE;'>#药物剂量#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=87690, encryptionId=19068e690ab, topicName=药物剂量)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=263b421, createdName=zhaozuguo, createdTime=Sat Aug 19 16:41:00 CST 2017, time=2017-08-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1356364, encodeId=dad31356364f9, content=<a href='/topic/show?id=b0702e84b9' target=_blank style='color:#2F92EE;'>#ART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2784, encryptionId=b0702e84b9, topicName=ART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Tue Jun 27 12:41:00 CST 2017, time=2017-06-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1438703, encodeId=13031438e03f1, content=<a href='/topic/show?id=5c6b516e1dd' target=_blank style='color:#2F92EE;'>#心脏衰竭#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51671, encryptionId=5c6b516e1dd, topicName=心脏衰竭)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Tue Jun 27 12:41:00 CST 2017, time=2017-06-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1562592, encodeId=b8571562592cf, content=<a href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=19, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80d715270048, createdName=slcumt, createdTime=Tue Jun 27 12:41:00 CST 2017, time=2017-06-27, status=1, ipAttribution=)]
  5. [GetPortalCommentsPageByObjectIdResponse(id=1843117, encodeId=d6cc184311eb9, content=<a href='/topic/show?id=3d052296e4e' target=_blank style='color:#2F92EE;'>#临床结局#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=22967, encryptionId=3d052296e4e, topicName=临床结局)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=7fbd46, createdName=mei531, createdTime=Mon Sep 11 05:41:00 CST 2017, time=2017-09-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1945094, encodeId=166219450942b, content=<a href='/topic/show?id=19068e690ab' target=_blank style='color:#2F92EE;'>#药物剂量#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=87690, encryptionId=19068e690ab, topicName=药物剂量)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=263b421, createdName=zhaozuguo, createdTime=Sat Aug 19 16:41:00 CST 2017, time=2017-08-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1356364, encodeId=dad31356364f9, content=<a href='/topic/show?id=b0702e84b9' target=_blank style='color:#2F92EE;'>#ART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2784, encryptionId=b0702e84b9, topicName=ART)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4c37265, createdName=zhaojie88, createdTime=Tue Jun 27 12:41:00 CST 2017, time=2017-06-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1438703, encodeId=13031438e03f1, content=<a href='/topic/show?id=5c6b516e1dd' target=_blank style='color:#2F92EE;'>#心脏衰竭#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=51671, encryptionId=5c6b516e1dd, topicName=心脏衰竭)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Tue Jun 27 12:41:00 CST 2017, time=2017-06-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1562592, encodeId=b8571562592cf, content=<a href='/topic/show?id=f69d864413' target=_blank style='color:#2F92EE;'>#HEART#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=19, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=8644, encryptionId=f69d864413, topicName=HEART)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=80d715270048, createdName=slcumt, createdTime=Tue Jun 27 12:41:00 CST 2017, time=2017-06-27, status=1, ipAttribution=)]
    2017-06-27 slcumt

相关资讯

Circulation:microRNA-146a在心衰的氧化代谢中起到关键作用!

心血管疾病仍然是世界死亡的主要原因,心衰的发病率也在逐年上升。尽管心衰的代谢改变渐渐被学者们发现,但针对这些代谢改变的治疗方法仍缺乏。

Eur J Heart Fail:日常用药短期漏服对心衰病理生理有何影响?

2017年5月,发表在《Eur J Heart Fail》的一项由英国和荷兰科学家进行的研究考察了每日用药的短期遗漏对心衰病理生理的影响。

JACC:心衰的诊断时间与患者预后的关系

目前,对于长期的慢性心衰而因急性心衰住院的患者与那些近期诊断为心衰的患者在哪些方面有不同尚未明确。近日,在国际心血管权威杂志JACC上发表了一篇旨在探索心衰的长期性对急性心衰患者临床和预后的影响的临床研究。

JACC:恶化的慢性心力衰竭VS.住院治疗期间近期确诊的心力衰竭

长期慢性心力衰竭者因急性心力衰竭而住院的患者与最近确诊为心衰患二者之间的区别目前尚不清楚。评估慢性心力衰竭与急性心力衰竭的病人概况和预后影响

Circulation:心衰患者活动量和预后的相关性研究!

物理活动(PA)与健康人群的不良心血管(CV)预后成反比关系,但是在心脏衰竭患者中,身体的活动量对射血分数(HFpEF)的影响研究还很少。在醛固酮拮抗剂治疗心力衰竭患者的心脏功能不全(Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist ,TOPCAT)临床试验中,本研究选取了175

心衰新药cimaglermin让人类第一次试验中看到治疗希望

心力衰竭患者有一个衰弱心脏,但研究人员表示,一种用于人类首次使用的试验性药物可能会修复心脏细胞,改善心脏功能。