A propensity score analysis of the impact of angiotensin-converting enzyme inhibitors on long-term survival of older adults with heart failure and perceived contra indications
A propensity score analysis of the impact of angiotensin-converting enzyme inhibitors on long-term survival of older adults with heart failure and perceived contra indications
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DOI：
10.1016/j.ahj.2004.06.030
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发表时间：
2005-04-01
影响因子：
4.8
通讯作者：
Perry, GJ
中科院分区：
文献类型：
--
作者：
Ahmed, A;Centor, RM;Perry, GJ
目的：本研究的目的是确定血管紧张素转换酶（ACE）抑制剂在患者出院时使用这些药物的反指征与主要出院诊断为收缩期心力衰竭的住院老年人出院后4年生存率之间的关系。背景：认知到ACE抑制剂的禁忌症通常与这些救命药物的使用不足有关。方法慢性肾功能不全、低血压、高钾血症和严重主动脉瓣狭窄为禁忌症。使用多变量逻辑回归模型，我们首先确定每个患者接受ACE抑制剂的倾向得分。使用双变量和多变量Cox比例风险分析来确定与未发现禁忌症且出院时使用ACE抑制剂的患者（参照组）相比的4年死亡率的粗风险和调整风险。结果与参照组相比，出院时未使用ACE抑制剂的患者4年死亡率显著增加2倍（校正风险比[HR] = 2.33, 95% CI = 1.30-4.19）。有明显禁忌症的患者出院时服用ACE抑制剂，4年死亡率（与参照组相比）增加23%（调整后HR = 1.23, 95% Cl = 0.71-2.13）。结论：出院时使用ACE抑制剂与被认为有这些药物禁忌症的患者的长期生存获益相关。
Objectives The purpose of this study is to determine the association between discharge use of angiotensin-converting enzyme (ACE) inhibitors in patients with perceived contra indications to these drugs and 4-year post-discharge survival among hospitalized older adults discharged alive with a primary discharge diagnosis of systolic heart failure.Background Perceived contraindications to the use of ACE inhibitors are often associated with underuse of these life-saving drugs.Methods Chronic renal insufficiency, hypotension, hyperkalemia, and severe aortic stenosis were conditions perceived as contraindications. Using a multivariable logistic regression model, we at first determined propensity scores for receipt of ACE inhibitors for each patient. Bivariate and multivariable Cox proportional hazard analyses were used to determine crude and adjusted risks of 4-year mortality compared with patients without perceived contraindications who were discharged on an ACE inhibitor (referent group).Results Compared with the referent group, patients with perceived contra indications who were not discharged on an ACE inhibitor had a significant 2-fold increase in the risk of 4-year mortality (adjusted hazard ratio [HR] = 2.33, 95% CI = 1.30-4.19). Patients with perceived contraindications who were discharged on ACE inhibitors had a non significant 23% higher risk of 4-year mortality (versus the referent group) (adjusted HR = 1.23, 95% Cl = 0.71-2.13).Conclusion Discharge use of ACE inhibitors was associated with significant long-term survival benefit in patients considered to have contraindication to these drugs.