Predischarge initiation of carvedilol in patients hospitalized for decompensated heart failure - Results of the Initiation Management Predischarge: Process for Assessment of Carvedilol Therapy in Heart Failure (IMPACT-HF) trial
Predischarge initiation of carvedilol in patients hospitalized for decompensated heart failure - Results of the Initiation Management Predischarge: Process for Assessment of Carvedilol Therapy in Heart Failure (IMPACT-HF) trial
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DOI：
10.1016/j.jacc.2003.12.040
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发表时间：
2004-05-05
影响因子：
24
通讯作者：
Gheorghiade, M
中科院分区：
文献类型：
--
作者：
Gattis, WA;O'Connor, CM;Gheorghiade, M
目的 出院前启动管理：心力衰竭卡维地洛治疗评估流程 (IMPACT-HF) 试验是一项由研究者发起的研究，旨在评估出院前是否使用卡维地洛。在因心力衰竭 (HF) 住院的病情稳定的患者中开始使用 β 受体阻滞剂增加了随机分组后 60 天时接受 β 受体阻滞剂治疗的患者数量，而没有增加副作用或住院时间。 背景 β 受体阻滞剂在 HF 中的使用不足。出院前启动可能会改善基于证据的 β 受体阻滞剂的使用。方法 IMPACT-HF 是一项前瞻性随机开放标签试验，在 363 名因 HF 住院的患者中进行。根据医生的判断，患者被随机分配到出院前开始卡维地洛或出院后开始（>2周）β-受体阻滞剂。该研究的主要终点是随机分组后 60 天接受 β 受体阻滞剂治疗的患者人数。次要终点包括停止β-受体阻滞剂的患者数量、达到的中位剂量以及死亡、再住院、因心衰而意外就诊或口服利尿剂增加小于或等于50%、新口服利尿剂或利尿剂、正性肌力药或其他血管活性药物的任何静脉治疗的复合终点。 结果 在 60 天时，165 名患者 (91.2%) 随机分配到出院前开始卡维地洛治疗与 130 名患者 (73.4%) 随机分配到出院后开始使用 β 受体阻滞剂相比 (p < 0.0001)。出院前启动与严重不良事件风险增加无关。两组的中位住院时间均为 5 天。 结论 对于因心力衰竭住院且病情稳定的患者，出院前开始使用卡维地洛可改善 60 天时 β 受体阻滞剂的使用，且不会增加副作用或住院时间。出院前启动可能是改善该人群β受体阻滞剂使用的一种方法。 (C) 2004 年由美国心脏病学会基金会资助。
OBJECTIVES The Initiation Management Predischarge: Process for Assessment of Carvedilol Therapy in Heart Failure (IMPACT-HF) trial was an investigator-initiated study to evaluate if predischarge carvedilol. initiation in stabilized patients hospitalized for heart failure (HF) increased the number of patients treated with beta-blockade at 60 days after randomization without increasing side effects or length of hospital stay.BACKGROUND Beta-blockers are underused in HF. Predischarge initiation may improve the use of evidence-based beta-blockade.METHODS The IMPACT-HF was a prospective, randomized open-label trial conducted in 363 patients hospitalized for HF. Patients were randomized to carvedilol initiation pre-hospital discharge or to postdischarge initiation (>2 weeks) of beta-blockade at the physicians' discretion. The primary end point of the study was the number of patients treated with beta-blockade at 60 days after randomization. Secondary end points included the number of patients discontinuing beta-blockade, median dose achieved, and a composite of death, rehospitalization, unscheduled visit for HF, or less than or equal to50% increase in oral diuretic, new oral diuretic, or any intravenous therapy with diuretics, inotropes, or other vasoactive agents.RESULTS At 60 days 165 patients (91.2%) randomized to predischarge carvedilol initiation were treated with a beta-blocker, compared with 130 patients (73.4%) randomized to initiation postdischarge (p < 0.0001). Predischarge initiation was not associated with an increased risk of serious adverse events. The median length of stay was five days in both groups.CONCLUSIONS Predischarge initiation of carvedilol in stabilized patients hospitalized for HF improved the use of beta-blockade at 60 days without increasing side effects or length of stay. Predischarge initiation may be one approach to improve beta-blocker use in this population. (C) 2004 by the American College of Cardiology Foundation.