Beta-Blockade With Nebivolol in Elderly Heart Failure Patients With Impaired and Preserved Left Ventricular Ejection Fraction Data From SENIORS (Study of Effects of Nebivolol Intervention on Outcomes and Rehospitalization in Seniors With Heart Failure)
Beta-Blockade With Nebivolol in Elderly Heart Failure Patients With Impaired and Preserved Left Ventricular Ejection Fraction Data From SENIORS (Study of Effects of Nebivolol Intervention on Outcomes and Rehospitalization in Seniors With Heart Failure)
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DOI：
10.1016/j.jacc.2009.02.046
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发表时间：
2009-06-09
影响因子：
24
通讯作者：
Flather, Marcus D.
中科院分区：
文献类型：
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作者：
van Veldhuisen, Dirk J.;Cohen-Solal, Alain;Flather, Marcus D.
目的 在这项 SENIORS（奈必洛尔干预对老年人心力衰竭结果和再住院的影响研究）试验的预先指定子分析中，研究了奈必洛尔对老年心力衰竭 (HF) 患者的影响，我们探讨了左心室射血分数 (EF) 对结果的影响，包括 EF 受损亚组 (35%)。 背景 β 受体阻滞剂是治疗 HF 和 EF 受损患者的既定药物，但它们在保留 EF 方面的价值尚不清楚。方法我们研究了 2,111 名患者； 1,359 人 (64%) 的 EF 受损 (35%)（平均 49.2%）。研究了奈必洛尔在这两组中的作用，并进行比较以探讨 EF 与结果的相互作用。随访时间为21个月；主要终点是全因死亡率或心血管住院。 结果 保留 EF 的患者多为女性（49.9% vs. 29.8%），且心力衰竭进展程度较低，高血压较多，既往心肌梗塞较少（全部 p < 0.001）。随访期间，主要终点发生在 465 名 EF 受损的患者 (34.2%) 和 235 名 EF 保留的患者 (31.2%) 中。奈必洛尔对主要终点的影响（奈必洛尔与安慰剂的风险比 [HR]）在 EF 受损的患者中为 0.86（95% 置信区间：0.72 至 1.04），在 EF 保留的患者中为 0.81（95% 置信区间：0.63 至 1.04）（亚组交互作用 p = 0.720）。组间对所有次要终点的影响相似（全因死亡率的 HR 分别为 0.84 和 0.91），并且没有交互作用的 p 值
Objectives In this pre-specified subanalysis of the SENIORS (Study of Effects of Nebivolol Intervention on Outcomes and Rehospitalization in Seniors With Heart Failure) trial, which examined the effects of nebivolol in elderly heart failure (HF) patients, we explored the effects of left ventricular ejection fraction (EF) on outcomes, including the subgroups impaired EF (35%).Background Beta-blockers are established drugs in patients with HF and impaired EF, but their value in preserved EF is unclear.Methods We studied 2,111 patients; 1,359 (64%) had impaired (35%) EF (mean 49.2%). The effect of nebivolol was investigated in these 2 groups, and it was compared to explore the interaction of EF with outcome. Follow-up was 21 months; the primary end point was all-cause mortality or cardiovascular hospitalizations.Results Patients with preserved EF were more often women (49.9% vs. 29.8%) and had less advanced HF, more hypertension, and fewer prior myocardial infarctions (all p < 0.001). During follow-up, the primary end point occurred in 465 patients (34.2%) with impaired EF and in 235 patients (31.2%) with preserved EF. The effect of nebivolol on the primary end point (hazard ratio [HR] of nebivolol vs. placebo) was 0.86 (95% confidence interval: 0.72 to 1.04) in patients with impaired EF and 0.81 (95% confidence interval: 0.63 to 1.04) in preserved EF (p = 0.720 for subgroup interaction). Effects on all secondary end points were similar between groups (HR for all-cause mortality 0.84 and 0.91, respectively), and no p value for interaction was