B-CONVINCED: Beta-blocker CONtinuation Vs. INterruption in patients with Congestive heart failure hospitalizED for a decompensation episode
B-CONVINCED: Beta-blocker CONtinuation Vs. INterruption in patients with Congestive heart failure hospitalizED for a decompensation episode
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DOI：
10.1093/eurheartj/ehp323
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发表时间：
2009-09-01
影响因子：
39.3
通讯作者：
Lechat, Philippe
中科院分区：
文献类型：
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作者：
Jondeau, Guillaume;Neuder, Yannick;Lechat, Philippe
在急性失代偿性心力衰竭(ADHF)期间是否应该停止β-受体阻滞剂治疗尚不确定。在一项随机、对照、开放标签、非劣势试验中，我们比较了在ADHF期间接受稳定的β-受体阻滞剂治疗的LVEF低于40%的患者继续使用β-受体阻滞剂和停止使用β-受体阻滞剂。共纳入169例患者，其中147例可评价。平均年龄为72+/-12岁，男性占65%。根据一位治疗失明的内科医生的说法，3天后，92.8%的接受β-受体阻滞剂的患者呼吸困难和总体幸福感都有所改善，而停止β-受体阻滞剂的患者中这一比例为92.3%。这是主要的终点，单侧95%可信区间的上限(6.6%)低于预先设定的上限(12.5%)，表明非劣势。在第8天，当患者做出评估时，也得到了类似的结果。第3天的血浆BNP、住院时间、再住院率和3个月后的死亡率也相似。在3个月时，90%的患者接受了β-受体阻滞剂治疗，而76%的患者接受了β-受体阻滞剂治疗(P<；0.05)。总体而言，在ADHF期间，继续使用β-受体阻滞剂治疗与延迟或较小的改善无关，但在3个月后长期服用β-受体阻滞剂的比率更高，这一好处是确定的。
Whether or not beta-blocker therapy should be stopped during acutely decompensated heart failure (ADHF) is unsure.In a randomized, controlled, open labelled, non-inferiority trial, we compared beta-blockade continuation vs. discontinuation during ADHF in patients with LVEF below 40% previously receiving stable beta-blocker therapy. 169 patients were included, among which 147 were evaluable. Mean age was 72 +/- 12 years, 65% were males. After 3 days, 92.8% of patients pursuing beta-blockade improved for both dyspnoea and general well-being according to a physician blinded for therapy vs. 92.3% of patients stopping beta-blocker. This was the main endpoint and the upper limit for unilateral 95% CI (6.6%) is lower that of the predefined upper limit (12.5%), indicating non-inferiority. Similar findings were obtained at 8 days and when evaluation was made by the patient. Plasma BNP at Day 3, length of hospital stay, re-hospitalization rate, and death rate after 3 months were also similar. Beta-blocker therapy at 3 months was given to 90% of patients vs. 76% (P < 0.05).In conclusion, during ADHF, continuation of beta-blocker therapy is not associated with delayed or lesser improvement, but with a higher rate of chronic prescription of beta-blocker therapy after 3 months, the benefit of which is well established.