Baseline characteristics and outcomes of patients with heart failure receiving bronchodilators in the CHARM programme
Baseline characteristics and outcomes of patients with heart failure receiving bronchodilators in the CHARM programme
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DOI：
10.1093/eurjhf/hfq040
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发表时间：
2010-06-01
影响因子：
18.2
通讯作者：
McMurray, John J. V.
中科院分区：
文献类型：
--
作者：
Hawkins, Nathaniel M.;Wang, Duolao;McMurray, John J. V.
心力衰竭（HF）和慢性阻塞性肺疾病是共同的伙伴。支气管扩张剂与肺部疾病患者的不良心血管结局相关。服用支气管扩张剂的心力衰竭患者的结局尚不明确。坎地沙坦治疗心力衰竭：死亡率和发病率降低评估 (CHARM) 计划将 7599 名有症状心力衰竭患者随机分组接受坎地沙坦或安慰剂治疗。使用多变量 Cox 比例风险模型检查支气管扩张剂治疗带来的相对风险。收缩功能降低和保留的患者中支气管扩张剂治疗的患病率相似（分别为 8.7% 和 9.2%，P = 0.46）。与未接受支气管扩张剂的患者相比，接受支气管扩张剂的患者的 β 受体阻滞剂利用率明显较低（总体为 31.9% vs. 57.6%，P < 0.0001）。支气管扩张剂的使用与全因死亡率增加[HR 1.26 (1.09-1.45)，P = 0.0015]、心血管死亡[HR 1.21 (1.03-1.42)，P = 0.0216]、心力衰竭住院[HR 1.49 (1.29-1.72)，P < 0.0001]和主要不良心血管事件[HR 1.32（1.17-1.76），P < 0.0001]。收缩功能降低和保留的患者的不良结果是一致的。在结果方面，支气管扩张剂和β-受体阻滞剂之间没有观察到显着的相互作用。支气管扩张剂的使用是广泛的心力衰竭患者心力衰竭恶化和死亡率增加的强有力的独立预测因素。这是否与支气管扩张剂的毒性作用、潜在的肺部疾病或两者有关尚不清楚，需要进一步研究。
Heart failure (HF) and chronic obstructive pulmonary disease are common partners. Bronchodilators are associated with adverse cardiovascular outcomes in patients with pulmonary disease. The outcome of patients with HF prescribed bronchodilators is poorly defined.The Candesartan in Heart failure: Assessment of Reduction in Mortality and morbidity (CHARM) programme randomized 7599 patients with symptomatic HF to receive candesartan or placebo. The relative risk conveyed by bronchodilator therapy was examined using a multivariable Cox proportional hazards model. The prevalence of bronchodilator therapy was similar in patients with reduced and preserved systolic function (respectively, 8.7 vs. 9.2%, P = 0.46). Beta-blocker utilization was markedly lower in patients receiving bronchodilators compared with those without (overall 31.9 vs. 57.6%, P < 0.0001). Bronchodilator use was associated with increased all-cause mortality [HR 1.26 (1.09-1.45), P = 0.0015], cardiovascular death [HR 1.21 (1.03-1.42), P = 0.0216], HF hospitalization [HR 1.49 (1.29-1.72), P < 0.0001], and major adverse cardiovascular events [HR 1.32 (1.17-1.76), P < 0.0001]. The adverse outcomes were consistent in patients with reduced and preserved systolic function. No significant interaction was observed between bronchodilators and beta-blockade with respect to outcomes.Bronchodilator use is a powerful independent predictor of worsening HF and increased mortality in a broad spectrum of patients with HF. Whether this relates to a toxic effect of bronchodilators, underlying pulmonary disease, or both is unclear and warrants further investigation.