Racial Differences in Quality of Life in Patients With Heart Failure Treated With Sodium-Glucose Cotransporter 2 Inhibitors: A Patient-Level Meta-Analysis of the CHIEF-HF, DEFINE-HF, and PRESERVED-HF Trials.
Racial Differences in Quality of Life in Patients With Heart Failure Treated With Sodium-Glucose Cotransporter 2 Inhibitors: A Patient-Level Meta-Analysis of the CHIEF-HF, DEFINE-HF, and PRESERVED-HF Trials.
复制标题
接受钠-葡萄糖协同转运蛋白 2 抑制剂治疗的心力衰竭患者生活质量的种族差异：CHIEF-HF、DEFINE-HF 和 PRESERVED-HF 试验的患者水平荟萃分析。
DOI：
10.1161/circulationaha.122.063263
复制
发表时间：
2023
期刊：
影响因子：
37.8
通讯作者：
Lanfear,DavidE
中科院分区：
文献类型：
--
作者：
Gupta,Kashvi;Spertus,JohnA;Birmingham,Mary;Gosch,KenseyL;Husain,Mansoor;Kitzman,DalaneW;Pitt,Bertram;Shah,SanjivJ;Januzzi,JamesL;Lingvay,Ildiko;Butler,Javed;Kosiborod,Mikhail;Lanfear,DavidE
背景与背景：与患有心力衰竭的白人患者相比，黑人患者的健康状况结果，包括症状、功能和生活质量，更差。钠-葡萄糖共转运体2抑制剂(SGLT2 Is)可降低心力衰竭患者的心血管死亡率并改善健康状况，但SGLT2 is的健康状况益处是否在不同种族之间相似尚未确定。这项研究的目的是比较SGLT2 IS(与安慰剂相比)对黑人和白人心力衰竭患者健康状况的治疗效果。方法我们结合了SGLT2 IS的3个随机临床试验的患者水平数据：DEFINE-HF(达格列齐对心力衰竭患者症状和生物标记物的影响；n=263)、RESTED-HF(达格列齐保留射血分数心力衰竭；n=324)和HEAD-HF(关于卡那格列齐对心力衰竭患者健康状况、生活质量和功能状态的影响的研究；n=448)。这3个以美国为基础的试验招募了相当大比例的黑人患者，每个试验都使用堪萨斯城心肌病问卷(KCCQ)来衡量基线和治疗12周后的健康状况。在1035名参与者中，选择信息完整的自我认同的黑人和白人患者产生了935名患者的最终分析队列。主要终点是KCCQ临床总结评分。通过使用根据试验、基线KCCQ(作为限制性三次样条)、种族和治疗进行调整的多变量线性回归模型来检验种族和治疗之间的交互作用，比较了在黑人和白人患者中使用SGLT2 is和安慰剂的KCCQ的12周变化。结果在935名参与者中，236名(25%)自认为是黑人，469名(50.2%)接受了SGLT2i治疗。与安慰剂相比，接受SGLT2i治疗的白人患者在12周时KCCQ临床总结评分提高了+4.0分(95%可信区间为1.7-6.3；P=0.0007)，黑人患者为+4.7点(95%可信区间为0.7-8.7；P=0.02)，种族和治疗没有显著影响(P=0.76)。其他KCCQ量表显示类似的结果。结论使用SGLT2i治疗导致黑人和白人心力衰竭患者的健康状况得到一致和显著的改善。
BACKGROUNDHealth status outcomes, including symptoms, function, and quality of life, are worse for Black compared with White patients with heart failure. Sodium–glucose cotransporter 2 inhibitors (SGLT2is) reduce cardiovascular mortality and improve health status in patients with heart failure, but whether the health status benefit of SGLT2is is similar across races is not established. The objective of this study was to compare the treatment effect of SGLT2is (versus placebo) on health status for Black compared with White patients with heart failure.METHODSWe combined patient-level data from 3 randomized clinical trials of SGLT2is: DEFINE-HF (Dapagliflozin Effect on Symptoms and Biomarkers in Patients With Heart Failure; n=263), PRESERVED-HF (Dapagliflozin in Preserved Ejection Fraction Heart Failure; n=324), and CHIEF-HF (A Study on Impact of Canagliflozin on Health Status, Quality of Life, and Functional Status in Heart Failure; n=448). These 3 United States–based trials enrolled a substantial proportion of Black patients, and each used the Kansas City Cardiomyopathy Questionnaire (KCCQ) to measure health status at baseline and after 12 weeks of treatment. Among 1035 total participants, selecting self-identified Black and White patients with complete information yielded a final analytic cohort of 935 patients. The primary endpoint was KCCQ Clinical Summary score. Twelve-week change in KCCQ with SGLT2is versus placebo was compared between Black and White patients by testing the interaction between race and treatment using multivariable linear regression models adjusted for trial, baseline KCCQ (as a restricted cubic spline), race, and treatment. The data that support the findings of this study are available from the corresponding author upon reasonable request.RESULTSAmong 935 participants, 236 (25%) self-identified as Black, and 469 (50.2%) were treated with an SGLT2i. Treatment with an SGLT2i, compared with placebo, resulted in KCCQ Clinical Summary score improvements at 12 weeks of +4.0 points (95% CI, 1.7–6.3;P=0.0007) in White patients and +4.7 points (95% CI, 0.7–8.7;P=0.02) in Black patients, with no significant interaction by race and treatment (P=0.76). Other KCCQ scales showed similar results.CONCLUSIONSTreatment with an SGLT2i resulted in consistent and significant improvements in health status for both Black and White patients with heart failure.