Heart rate determines the beneficial effects of beta-blockers on cardiovascular outcomes in patients with heart failure and atrial fibrillation
Heart rate determines the beneficial effects of beta-blockers on cardiovascular outcomes in patients with heart failure and atrial fibrillation
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心率决定了β受体阻滞剂对心力衰竭和心房颤动患者心血管结局的有益影响
DOI：
10.1038/s41440-019-0289-4
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发表时间：
2019
影响因子：
5.4
通讯作者：
Kitakaze Masafumi
中科院分区：
文献类型：
--
作者：
Hudoyo Athanasius Wrin;Fukuda Hiroki;Imazu Miki;Shindo Kazuhiro;Fu Haiying;Iwata Yuko;Ito Shin;Kitakaze Masafumi
β受体阻滞剂被推荐作为心力衰竭（HF）患者的标准治疗。然而，据报道，与窦性心律（SR）患者相比，β受体阻滞剂在房颤（Af）HF患者中的疗效较差。在这里，我们研究了出院时的HR是否决定了接受β受体阻滞剂治疗的Af HF患者的心血管结局。在这项分析中，我们纳入了97例合并房颤的HF患者。这些患者根据β受体阻滞剂的使用和出院HR的三分位数分为6组：最低<60次/分钟（bpm），中间61-70 bpm和最高>71 bpm。主要终点定义为因HF恶化而再次住院和全因死亡的复合终点。在出院后772天的中位随访期间，分别有37例（61%）和25例（69%）患者使用或未使用β受体阻滞剂发生复合心血管结局。在考克斯比例风险分析中，在两个未校正模型中，与中间和最高三分位数相比，β受体阻滞剂患者的最低HR三分位数与复合结局风险增加相关（风险比：2.568，95%可信区间（CI）：1.089- 6.057，p = 0.031;风险比：2.024，95%可信区间（CI）：0.921- 4.447，p = 0.079）和校正潜在混杂因素的模型（危险比：2.631，95%CI：1.078- 6.421，p = 0.034;危险比：2.876，95%CI：1.147- 7.207，p = 0.024）。在接受β受体阻滞剂治疗的HF和Af患者中，低HR不利地增加了心血管事件的风险。这一事实可能会削弱β受体阻滞剂对HF和AF患者的有益作用。
Beta-blockers are recommended as a standard therapy for patients with heart failure (HF). However, beta-blockers are reportedly less effective in HF patients with atrial fibrillation (Af) compared with those with sinus rhythm (SR). Here, we investigated whether HR at discharge determined the cardiovascular outcomes in HF patients with Af treated with beta-blockers. In this analysis, we enrolled 97 HF patients with concomitant Af. These patients were divided into 6 groups according to beta-blocker use and tertiles of discharge HR: lowest <60 beats per minute (bpm), middle 61–70 bpm and highest >71 bpm. The primary endpoint was defined as a composite of rehospitalization due to worsening of HF and all-cause mortality. During a median follow-up of 772 days after discharge, the composite cardiovascular outcome occurred in 37 (61%) and 25 (69%) patients with or without beta-blockers, respectively. In the Cox proportional hazard analysis, the lowest HR tertile in patients with beta-blockers was associated with an increased risk of the composite outcome compared with the middle and highest tertiles in both the unadjusted model (hazard ratio: 2.568, 95% confidence interval (CI): 1.089–6.057,p= 0.031; hazard ratio: 2.024, 95% CI: 0.921–4.447,p= 0.079, respectively) and the model adjusted for potential confounders (hazard ratio: 2.631, 95% CI: 1.078–6.421,p= 0.034; hazard ratio: 2.876, 95% CI: 1.147–7.207,p= 0.024, respectively). In patients with HF and Af receiving beta-blockers, low HR adversely increased the risk of cardiovascular events. This fact may blunt the beneficial effects of beta-blockers in patients with HF and Af.