Falling Cardiovascular Mortality in Heart Failure With Reduced Ejection Fraction and Implications for Clinical Trials
Falling Cardiovascular Mortality in Heart Failure With Reduced Ejection Fraction and Implications for Clinical Trials
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DOI：
10.1016/j.jchf.2015.03.013
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发表时间：
2015-08-01
影响因子：
13
通讯作者：
McMurray, John J. V.
中科院分区：
文献类型：
--
作者：
Rush, Christopher J.;Campbell, Ross T.;McMurray, John J. V.
目的 本研究根据在射血分数降低的心力衰竭 (HF-REF) 患者的临床试验中使用 β 受体阻滞剂，探讨了心血管和非心血管死亡率对总死亡率的相对贡献趋势。 背景 随着 HF-REF 中疾病缓解疗法（尤其是 β 受体阻滞剂）的日益广泛使用，死于心血管原因的患者比例可能会下降。 方法 在一项系统评价中，两名研究人员独立检索在线数据库以识别临床试验包括 1986 年至 2014 年间发表的超过 400 名慢性心力衰竭患者的死亡原因。试验根据接受 β 受体阻滞剂治疗的患者比例（66% [高]）分为 3 组。通过加权平均值和加权标准差计算被判定为心血管或非心血管疾病的总死亡百分比。使用加权Student t 检验来比较组间结果。 结果 66 项试验符合纳入标准，共有 136,182 名患者和 32,140 例死亡。随着 β 受体阻滞剂使用量的增加，非心血管死亡的百分比连续增加，从低 β 受体阻滞剂使用试验中所有死亡的 11.4% 增加到高 β 受体阻滞剂使用试验中的 19.1% (p < 0.001)。 结论 在 HF-REF 患者的试验中，被判定为心血管死亡的比例有所下降。心血管死亡率而非全因死亡率应作为 HF-REF 新疗法试验的终点。 (C) 2015 年，美国心脏病学会基金会。
OBJECTIVES This study examined the trends in the relative contributions of cardiovascular and noncardiovascular mortality to total mortality according to use of beta-blockers in clinical trials of patients with heart failure with reduced ejection fraction (HF-REF).BACKGROUND With the increasingly widespread use of disease-modifying therapies, particularly beta-blockers, in HF-REF, the proportion of patients dying from cardiovascular causes is likely to be decreasing.METHODS In a systematic review, 2 investigators independently searched online databases to identify clinical trials including > 400 patients with chronic heart failure published between 1986 and 2014 and that adjudicated cause of death. Trials were divided into 3 groups on the basis of the proportion of patients treated with a beta-blocker ( 66% [high]). Percentages of total deaths adjudicated as cardiovascular or noncardiovascular were calculated by weighted means and weighted standard deviations. Weighted Student t tests were used to compare results between groups.RESULTS Sixty-six trials met the inclusion criteria with a total of 136,182 patients and 32,140 deaths. There was a sequential increase in the percentage of noncardiovascular deaths with increasing beta-blocker use from 11.4% of all deaths in trials with low beta-blocker use to 19.1% in those with high beta-blocker use (p < 0.001).CONCLUSIONS In trials of patients with HF-REF, the proportion of deaths adjudicated as cardiovascular has decreased. Cardiovascular mortality, and not all-cause mortality, shouldbe used as an endpoint for trials of new treatments for HF-REF. (C) 2015 by the American College of Cardiology Foundation.