有心房颤动和无心房颤动的心力衰竭患者目前使用β-受体阻滞剂的情况:全国数据库分析。

IF 6.3 2区 医学 Q1 PHARMACOLOGY & PHARMACY Clinical Pharmacology & Therapeutics Pub Date : 2024-11-18 DOI:10.1002/cpt.3496
Michikazu Nakai, Yoshitaka Iwanaga, Koshiro Kanaoka, Yoko Sumita, Yuichi Nishioka, Tomoya Myojin, Katsuki Okada, Tatsuya Noda, Tomoaki Imamura, Yoshihiro Miyamoto
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引用次数: 0

摘要

在当代人群中,β-受体阻滞剂对心力衰竭(HF)和心房颤动(AF)的有效性证据尚存在争议。本研究调查了日本有房颤和无房颤的住院高血压患者使用β-受体阻滞剂与预后之间的关系。研究人员从2014年4月至2021年3月期间的日本全国健康保险索赔和特定健康检查数据库中找到了首次急性心房颤动住院患者。通过倾向得分匹配法比较了心房颤动组和非心房颤动组患者使用β受体阻滞剂与预后的关系。研究采用了混合效应生存模型,并计算了危险比 (HR) 和 95% 置信区间 (CI)。在 4,433 家医院的 428,650 名因心房颤动出院的患者中,175,174 人(40.9%)年龄≥ 85 岁,151,873 人(35.4%)患有复杂性心房颤动,236,457 人(55.2%)使用过 β 受体阻滞剂。在匹配的心房颤动组中,β-受体阻滞剂的使用与较低的全因死亡率或高血压再住院综合结果相关(HR [95%CI],0.95 [0.93-0.97])。在匹配的非房颤组中也得到了类似的结果(0.95 [0.94-0.96])。此外,心房颤动组中年龄≥ 85 岁的患者和女性患者的 HR 分别为 1.00 [0.98-1.02] 和 1.01 [0.98-1.03],非心房颤动组中的 HR 分别为 1.03 [1.01-1.05] 和 0.98 [0.97-1.00]。在一个超高龄社会中,无论房颤与否,使用β受体阻滞剂都能为各种类型的心房颤动患者带来有利的预后。
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Contemporary Use of β-Blockers in Heart Failure Patients With and Without Atrial Fibrillation: A Nationwide Database Analysis.

Evidence of the effectiveness of β-blockers in heart failure (HF) and atrial fibrillation (AF) in a contemporary cohort is controversial. This study investigated the association between the use of β-blockers and prognosis in hospitalized HF patients with and without AF in Japan. Patients hospitalized with the first episode of acute HF were identified from the National Database of Health Insurance Claims and Specific Health Checkups of Japan between April 2014 and March 2021. Associations of β-blocker use and prognosis were compared by propensity score matching among the AF or non-AF group. A mixed-effects survival model was used, and hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated. Among 428,650 patients discharged with HF in 4,433 hospitals, 175,174 (40.9%) were ≥ 85 years old, 151,873 (35.4%) had complicated AF, and 236,457 (55.2%) were β-blocker users. In a matched AF group, β-blocker use was associated with a lower composite outcome of all-cause mortality or HF rehospitalization (HR [95% CI], 0.95 [0.93-0.97]). A similar result was obtained in a matched non-AF group (0.95 [0.94-0.96]). In addition, the HRs in patients aged ≥ 85 years and female patients were 1.00 [0.98-1.02] and 1.01 [0.98-1.03] in the AF group and 1.03 [1.01-1.05] and 0.98 [0.97-1.00] in the non-AF group, respectively. The favorable prognostic associations of β-blocker use were observed regardless of AF in patients across a broad spectrum of HF in a superaged society.

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来源期刊
CiteScore
12.70
自引率
7.50%
发文量
290
审稿时长
2 months
期刊介绍: Clinical Pharmacology & Therapeutics (CPT) is the authoritative cross-disciplinary journal in experimental and clinical medicine devoted to publishing advances in the nature, action, efficacy, and evaluation of therapeutics. CPT welcomes original Articles in the emerging areas of translational, predictive and personalized medicine; new therapeutic modalities including gene and cell therapies; pharmacogenomics, proteomics and metabolomics; bioinformation and applied systems biology complementing areas of pharmacokinetics and pharmacodynamics, human investigation and clinical trials, pharmacovigilence, pharmacoepidemiology, pharmacometrics, and population pharmacology.
期刊最新文献
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