Comparative effectiveness of beta-adrenergic antagonists (atenolol, metoprolol tartrate, carvedilol) on the risk of rehospitalization in adults with heart failure
Comparative effectiveness of beta-adrenergic antagonists (atenolol, metoprolol tartrate, carvedilol) on the risk of rehospitalization in adults with heart failure
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DOI：
10.1016/j.amjcard.2007.03.084
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发表时间：
2007-08-15
影响因子：
2.8
通讯作者：
Platt, Richard
中科院分区：
文献类型：
--
作者：
Go, Alan S.;Yang, Jingrong;Platt, Richard
安慰剂对照随机试验已经证明了选定的β受体阻滞剂对慢性心力衰竭(HF)的疗效，但不同P受体阻滞剂在常规临床治疗中的相对有效性尚不清楚。我们比较了2001年1月1日至2002年12月31日期间在两个大型健康计划内因心力衰竭住院的7883名成人中，因心力衰竭再次住院的12个月风险与接受不同的β受体阻滞剂的关系。从电子药房数据库中确定β-受体阻滞剂的使用情况，并从医院出院数据库中确定12个月内再次住院的情况。使用扩展COX回归分析在调整潜在混杂因素后，接受不同的P受体阻滞剂治疗与心力衰竭再入院风险之间的关系。在随访期间，有3234人年暴露于0阻滞剂(39.3%阿替洛尔、42.0%酒石酸美托洛尔、12.3%卡维地洛和6.4%其他)。心力衰竭患者12个月再住院率总体较高(每100人年42.6人)。在调整了潜在的混杂因素、对每种P阻滞剂的累积暴露以及接受卡维地洛治疗的倾向后，与阿替洛尔相比，酒石酸美托洛尔(调整后的危险比0.95，95%可信区间0.85至1.05)或卡维地洛(调整后的危险比0.92，95%可信区间0.74至1.14)的调整后的再入院风险没有显著差异。总而言之，在当代高危心力衰竭患者中，我们发现接受阿替洛尔、短效酒石酸美托洛尔或卡维地洛的患者在12个月内因心力衰竭再次住院的调整风险没有显著差异。(C)2007 Elsevier Inc.保留所有权利。
Placebo-controlled randomized trials have demonstrated the efficacy of selected beta blockers on outcomes in chronic heart failure (HF), but the relative effectiveness of different P blockers in usual clinical care is poorly understood. We compared 12-month risk of rehospitalization for HF associated with receipt of different beta blockers in 7,883 adults hospitalized for HF within 2 large health plans between January 1, 2001 and December 31, 2002. Beta-blocker use was ascertained from electronic pharmacy databases and readmissions within 12 months were identified from hospital discharge databases. Extended Cox regression was used to examine the association between receipt of different P blockers and risk of readmission for HF after adjustment for potential confounders. During follow-up, there were 3,234 person-years of exposure to 0 blockers (39.3% atenolol, 42.0% metoprolol tartrate, 12.3% carvedilol, and 6.4% other). Crude 12-month rates of readmissions for HF were high overall (42.6 per 100 person-years). After adjustment for potential confounders, cumulative exposure to each P blocker, and propensity to receive carvedilol compared with atenolol, adjusted risks of readmission were not significantly different for metoprolol tartrate (adjusted hazard ratio 0.95, 95% confidence interval 0.85 to 1.05) or for carvedilol (adjusted hazard ratio 0.92, 95% confidence interval 0.74 to 1.14). In conclusion, in a contemporary cohort of high-risk patients hospitalized with HF, we found that adjusted risks of rehospitalization for HF within 12 months were not significantly different in patients receiving atenolol, shorter-acting metoprolol tartrate, or carvedilol. (c) 2007 Elsevier Inc. All rights reserved.