Conventional medical therapy in heart failure patients eligible for the PARADIGM-HF, DAPA-HF, and SHIFT trials
Conventional medical therapy in heart failure patients eligible for the PARADIGM-HF, DAPA-HF, and SHIFT trials
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DOI：
10.1016/j.ijcard.2022.04.020
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发表时间：
2022-05-26
影响因子：
3.5
通讯作者：
Yoshikawa，Tsutomu
中科院分区：
文献类型：
--
作者：
Shoji，Satoshi;Kohsaka，Shun;Yoshikawa，Tsutomu
背景最近关于新型心力衰竭（HF）治疗（血管紧张素受体-脑啡肽酶抑制剂、钠-葡萄糖协同转运蛋白2抑制剂和伊伐布雷定）的试验强调使用常规药物治疗（血管紧张素转换酶抑制剂、β受体阻滞剂[BB]和矿物皮质类固醇受体拮抗剂）。我们的目的是评估处方率的常规药物治疗和其相关性与长期结果的患者符合最近的trials.MethodsWe检查了1295例连续HF患者的射血分数降低（HFrEF）从多中心注册（WET-HF注册）。我们评估了符合PARADIGM-HF/DAPA-HF和入选标准的患者的常规药物治疗实施情况。我们还研究了传统的药物治疗的使用和长期的结果之间的关联，在每个入组criteris.ResultsOverall，62.2%和35.3%的HFrEF患者符合入组标准的PARADIGM-HF/DAPA-HF和ESTA试验。在每个患者亚组中，仅33.9%和31.9%接受了完整的常规药物治疗。值得注意的是，84.2%符合入选标准的患者接受了BB治疗，分别只有23.0%和4.4%的患者接受了≥50%或全部推荐剂量。在PARADIGM-HF/DAPA-HF合格组中，实施完全常规药物治疗与较低的2年死亡率和HF再入院率相关（HR 0. 68，95% CI 0. 50 - 0. 92）。BB在≥50%的推荐剂量的使用与较低的2年死亡率和HF再入院率在SHIFT合格组（HR 0.50，95%CI 0.30-0.84）。需要进一步努力优化传统的医学治疗。
BackgroundRecent trials on novel heart failure (HF) treatments (angiotensin receptor-neprilysin inhibitor, sodium-glucose cotransporter 2 inhibitor, and ivabradine) emphasize the use of conventional medical therapy (angiotensin-converting enzyme inhibitors, beta-blockers [BB], and mineral corticosteroid receptor antagonists). We aimed to evaluate the prescription rate of conventional medical therapy and its association with long-term outcomes in patients eligible for recent trials.MethodsWe examined 1295 consecutive patients with HF with reduced ejection fraction (HFrEF) from a multicenter registry (WET-HF registry). We assessed conventional medical therapy implementation among patients meeting the PARADIGM-HF/DAPA-HF and SHIFT enrollment criteria. We also examined the association between conventional medical therapy use and long-term outcomes within each enrollment criterion.ResultsOverall, 62.2% and 35.3% of HFrEF patients met the enrollment criteria of the PARADIGM-HF/DAPA-HF and SHIFT trials. Only 33.9% and 31.9% received full conventional medical therapy within each patient subset. Notably, 84.2% of patients who met the SHIFT enrollment criteria were on BB, and only 23.0% and 4.4% were on ≥50% or the full recommended dose, respectively. Implementation of full conventional medical therapy use was associated with lower 2-year mortality and HF readmission rates in the PARADIGM-HF/ DAPA-HF eligible group (HR 0.68, 95% CI 0.50–0.92). The use of BB at ≥50% of the recommended dose was associated with lower 2-year mortality and HF readmission rates in the SHIFT-eligible group (HR 0.50, 95% CI 0.30–0.84).ConclusionsConventional medical therapy was underutilized among patients eligible for novel trials within a Japanese HF registry. Further efforts to optimize conventional medical therapy are needed.