Clinical effectiveness of beta-blockers in heart failure: findings from the OPTIMIZE-HF (Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure) Registry.
Clinical effectiveness of beta-blockers in heart failure: findings from the OPTIMIZE-HF (Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure) Registry.
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DOI：
10.1016/j.jacc.2008.09.031
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发表时间：
2009-01-13
影响因子：
24
通讯作者：
Fonarow, Gregg C.
中科院分区：
文献类型：
--
作者：
Hernandez, Adrian F.;Hammill, Bradley G.;O'Connor, Christopher M.;Schulman, Kevin A.;Curtis, Lesley H.;Fonarow, Gregg C.
我们试图研究老年心力衰竭住院患者开始β受体阻滞剂治疗与预后之间的关系。β受体阻滞剂是指南推荐的心力衰竭治疗方法，但其临床有效性尚不清楚，尤其是在老年患者中。我们将医疗保险索赔数据与OPTIMIZE-HF记录合并，以检查新开始β受体阻滞剂治疗的合格患者的长期结局。我们使用逆概率加权考克斯比例风险模型来确定治疗与死亡率、再住院治疗以及死亡率-再住院治疗联合终点之间的关系。观察1年死亡率为33%，全因再住院率为64%。在7154例因心力衰竭住院并适合β受体阻滞剂治疗的患者中，3421例（49%）新开始β受体阻滞剂治疗。在左心室收缩功能不全患者中，（LVSD; n = 3001），β受体阻滞剂与死亡率的校正风险比为0.77（95%置信区间[CI]，0.68-0.87），再住院率为0.89（95% CI，0.80-0.99），死亡率-再住院率为0.87（95% CI，0.79-0.96）相关。在收缩功能保留的患者中（n = 4153），β受体阻滞剂与死亡率的校正风险比为0.94（95% CI，0.84-1.07），与再住院的校正风险比为0.98（95% CI，0.90-1.06），与死亡-再住院的校正风险比为0.98（95% CI，0.91-1.06）。在因心力衰竭和LVSD住院的老年患者中，β受体阻滞剂的使用在临床上是有效的，并且与死亡和再住院的风险较低独立相关。收缩功能保留的患者预后较差，β受体阻滞剂对这些患者的死亡率和再住院风险无显著影响。
We sought to examine associations between initiation of beta-blocker therapy and outcomes among elderly patients hospitalized for heart failure. Beta-blockers are guideline-recommended therapy for heart failure, but their clinical effectiveness is not well-understood, especially in elderly patients. We merged Medicare claims data with OPTIMIZE-HF records to examine long-term outcomes of eligible patients newly initiated on beta-blocker therapy. We used inverse probability-weighted Cox proportional hazards models to determine the relationships between treatment and mortality, rehospitalization, and a combined mortality–rehospitalization endpoint. Observed 1-year mortality was 33%, and all-cause rehospitalization was 64%. Among 7154 patients hospitalized with heart failure and eligible for beta-blockers, 3421 (49%) were newly initiated on beta-blocker therapy. Among patients with left ventricular systolic dysfunction (LVSD; n = 3001), beta-blockers were associated with adjusted hazard ratios of 0.77 (95% confidence interval [CI], 0.68–0.87) for mortality, 0.89 (95% CI, 0.80–0.99) for rehospitalization, and 0.87 (95% CI, 0.79–0.96) for mortality–rehospitalization. Among patients with preserved systolic function (n = 4153), beta-blockers were associated with adjusted hazard ratios of 0.94 (95% CI, 0.84–1.07) for mortality, 0.98 (95% CI, 0.90–1.06) for rehospitalization, and 0.98 (95% CI, 0.91–1.06) for mortality-rehospitalization. In elderly patients hospitalized with heart failure and LVSD, incident beta-blocker use was clinically effective and independently associated with lower risks of death and rehospitalization. Patients with preserved systolic function had poor outcomes, and beta-blockers did not significantly influence the mortality and rehospitalization risks for these patients.
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