Carvedilol use at discharge in patients hospitalized for heart failure is associated with improved survival: An analysis from Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF)
Carvedilol use at discharge in patients hospitalized for heart failure is associated with improved survival: An analysis from Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF)
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DOI：
10.1016/j.ahj.2006.10.008
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发表时间：
2007-01-01
影响因子：
4.8
通讯作者：
Young, James B.
中科院分区：
文献类型：
--
作者：
Fonarow, Gregg C.;Abraham, William T.;Young, James B.
背景 IMPACT-HF 试验表明，心力衰竭 (HF) 出院时使用卡维地洛可显着提高出院后 90 天的治疗率。对于因心力衰竭住院的患者来说，这种治疗方法是否能带来早期生存获益尚不清楚。我们检查了因心力衰竭和左心室收缩功能障碍 (LVSD) 住院的患者出院时使用卡维地洛对死亡率和再住院的早期影响，并与出院前符合条件但未接受β受体阻滞剂治疗的患者的结局进行比较。方法 OPTIMIZE-HF 计划在 91 家医院的网络登记处登记了 5791 名因心力衰竭入院的患者，从 3 月份开始进行预先设定的 60 至 90 天随访2003 年至 2004 年 12 月。前瞻性收集符合 β 受体阻滞剂治疗资格的患者的结果数据，并根据出院前 β 受体阻滞剂的使用情况进行分析。结果 平均年龄为 69.7 岁； 63% 为男性，52% 为缺血性，平均左心室射血分数为 24.3%。共有 2720 名患者患有 LVSD，其中 2373 名患者（87.2%）有资格在出院时接受 β 黑剂治疗，1162 名患者（49.0%）接受了卡维地洛治疗。与出院前未使用β-blacker相比，出院使用卡维地洛可显着降低60至90天的死亡风险（风险比0.46，P = .0006）以及死亡率或再住院（比值比0.71，P = .0175）。出院前使用卡维地洛的耐受性良好，在 60 至 90 天的随访中继续治疗的比率很高。其他基于证据的β受体阻滞剂也观察到类似的结果。 结论 心衰出院时使用卡维地洛耐受性良好，可提高治疗率，并与早期生存获益相关。这些发现为指南建议提供了进一步的支持，即对于稳定的心力衰竭和 LVSD 患者，应在出院前开始使用卡维地洛或其他基于证据的 β 黑剂。
Background The IMPACT-HF trial demonstrated that carvedilol use at the time of heart failure (HF) hospital discharge significantly increased 90-day postdischarge treatment rates. Whether there is an early survival benefit associated with this therapeutic approach in patients hospitalized for HF is unknown. We examined the early effects on mortality and rehospitalization of carvedilol use at discharge in patients hospitalized for HF and left ventricular systolic dysfunction (LVSD) compared with outcomes in patients who are eligible for, but do not receive, beta blockers before discharge.Methods The OPTIMIZE-HF program enrolled 5791 patients admitted with HF in a web-based registry at 91 hospitals participating with prespecified 60- to 90-day follow-up from March 2003 to December 2004. Outcomes data were prospectively collected on patients eligible for beta-blocker therapy and analyzed according to predischarge beta-blocker use.Results The mean age was 69.7 years; 63% were male, etiology was ischemic in 52%, and mean left ventricular ejection fraction was 24.3%. A total of 2720 patients had LVSD, among whom 2373 (87.2%) were eligible to receive a beta blacker at discharge and carvedilol was prescribed in 1162 (49.0%). Discharge use of carvedilol was associated with a significant reduction in mortality risk at 60 to 90 days (hazard ratio 0.46, P =.0006) and mortality or rehospitalization (odds ratio 0.71, P = .0175) compared to no predischarge beta blacker. Predischarge use of carvedilol was well tolerated with high rates of continued therapy at 60 to 90 days follow-up. Similar findings were observed for other evidence-based beta blockers.Conclusions Carvedilol use at the time of HF hospital discharge is well tolerated, improves treatment rates, and is associated with an early survival benefit. These findings provide further support for guideline recommendations that carvedilol or other evidence-based beta blacker should be initiated before hospital discharge in stable patients with HF and LVSD.