Beta-blockers in heart failure with preserved ejection fraction: a meta-analysis
Beta-blockers in heart failure with preserved ejection fraction: a meta-analysis
复制标题
DOI：
10.1007/s10741-014-9453-8
复制
发表时间：
2015-03-01
影响因子：
4.6
通讯作者：
Messerli, Franz H.
中科院分区：
文献类型：
--
作者：
Bavishi, Chirag;Chatterjee, Saurav;Messerli, Franz H.
β受体阻滞剂是治疗射血分数降低心衰的既定药物，但其在保留射血分数（HFpEF）心衰中的作用尚未确定。因此，我们进行了一项荟萃分析，以评估-受体阻滞剂对HFpEF患者死亡率和发病率的疗效。使用PubMed、Embase、Scopus和Cochrane数据库进行系统检索，以确定β受体阻滞剂和HFpEF的所有相关研究。采用随机效应模型评估β受体阻滞剂对全因死亡率和心衰住院率的作用。共纳入了15项观察性研究和2项随机对照试验，共涉及27,099例患者。在观察性研究中，受体阻滞剂治疗与较低的全因死亡率相关[RR 0.81 (0.72-0.90), p < 0.001]，但与HF住院率无关[RR 0.79 (0.57-1.10), p < 0.001]。然而，在这两项随机对照试验中，β受体阻滞剂的使用与全因死亡率[RR 0.94 (0.67-1.32), p = 0.72]或HF住院率[0.90 (0.54-1.49),p = 0.68]无关。结果与地理区域（美国与世界其他地区）和射血分数亚组一致。亚组分析显示，β受体阻滞剂的有益生存效应仅限于平均年龄< 75岁的研究。观察性研究显示，使用-受体阻滞剂对全因死亡率有显著益处，但对心衰住院治疗无显著益处。在两项随机对照试验中，β受体阻滞剂与全因死亡率或HF住院率的显著降低无关；然而，这两项试验都没有足够的动力，随访率的损失也很高。进一步的大样本、良好的随机试验是有必要的，以证实β受体阻滞剂对死亡率和住院率的影响。
Beta-blockers are established drugs in heart failure with reduced ejection fraction, but their role in heart failure with preserved ejection fraction (HFpEF) is not established. Hence, we undertook a meta-analysis to evaluate the efficacy of beta-blockers on mortality and morbidity in HFpEF patients. A systematic search using PubMed, Embase, Scopus and Cochrane databases was performed to identify all relevant studies on beta-blockers and HFpEF. A random-effects model was performed to assess the role of beta-blockers on all-cause mortality and HF hospitalization. Overall 15 observational studies and two randomized control trial involving a total of 27,099 patients were included in the analysis. In the observational studies, beta-blocker therapy was associated with lower all-cause mortality [RR 0.81 (0.72-0.90), p < 0.001], but not HF hospitalization [RR 0.79 (0.57-1.10), p < 0.001]. However, in the two RCTs, the use of beta-blocker was not associated with all-cause mortality [RR 0.94 (0.67-1.32), p = 0.72] or HF hospitalization [0.90 (0.54-1.49), p = 0.68]. The results were consistent by geographic region (USA vs. rest of world) and ejection fraction subgroups. Subgroup analysis revealed that the beneficial survival effect of beta-blocker was limited to studies with mean age < 75 years. Observational studies showed a significant benefit from the use of beta-blockers for all-cause mortality, but not for HF hospitalization. Beta-blockers in the two RCTs were not associated with significant reduction in all-cause mortality or HF hospitalization; however, both the trials were not adequately powered and had high loss to follow-up rates. Further large sampled well-conducted randomized trials are warranted to confirm the effects of beta-blockers on mortality and hospitalization.