慢性射血分数降低心力衰竭患者出院用药调查及对预后的影响

Survey on the medications at discharge and its effects on prognosis in chronic heart failure patients with reduced ejection fraction

目的了解慢性射血分数降低心力衰竭(简称心衰)患者服用指南推荐药物情况及其对预后的影响。方法这是一项单中心回顾性研究,对2007年1月1日至2009年12月31日在本院住院诊断为慢性心衰且左室射血分数(LVEF)≤0.45的患者通过查阅住院、门诊病历和电话随访进行研究。研究出院时服用药物对全因死亡,以及全因死亡或心源性再住院的影响。结果共187例患者组成研究人群,中位数随访18个月(2～41个月),92%患者出院时服用β受体阻滞剂,79%患者服用血管紧张素转换酶抑制剂/血管紧张素Ⅱ受体拮抗剂(ACEI/ARB),67%患者服用他汀类药物,62%患者服用利尿剂,40%患者服用醛固酮受体拮抗剂,34%患者服用地高辛。全因死亡率为19%,全因死亡或首次心源性再住院率为41%。LVEF≤0.35慢性心衰患者全因死亡率以及全因死亡或首次心源性再住院率分别为27%和53%。校正多重因素后全因死亡的预测因子为年龄(HR 1.34/每增加10岁,95%可信区间1.01～1.77)、NYHA心功能分级(HR 3.17/NYHA每增加1级,95%可信区间1.94～5.19)和慢性肾脏病(CKD)分期(HR 1.85/CKD每增加1期,95%可信区间1.12～3.05),以及出院时服用β受体阻滞剂(HR 0.38,95%可信区间0.15～0.93)和他汀类药物(HR 0.44,95%可信区间0.22～0.88)。结论大多数慢性射血分数降低患者出院时服用了指南推荐的药物,但这部分患者预后差,特别是LVEF≤0.35患者。β受体阻滞剂、ACEI/ARB和他汀类药物能改善预后。

Objective To investigate the use of medications recommended by guidelines for chronic heart failure patients with reduced ejection fraction and its effects on prognosis. Methods The investigation was a single center, retro-spective study. A total of 242 consecutive heart failure patients with left ventricular ejection fraction （LVEF） ≤0.45 from January 1, 2007 to December 31,2009, were enrolled. Medical records were reviewed and followed-up through telephone. To assess the relationship between all-cause mortality, and all-canse mortality or the first cardiovascular readmission event with the medications at discharge. Results A total of 187 patients composed the study samples, the median follow-up was 18 （2 -41 ） months. β-blockers at discharge was used in 92% patients, ACEI/ARB in 79% patients, statins in 67% patients, diuretics in 62%, aldosterone receptor antagonist in 40% and digoxin in 34%. All-cause mortality was 19%. All-cause mortality plus first cardiovascular readmission rate was 41%. All-cause mortality and all-cause mortality plus first cardiovascular readmission rates for patient with LVEF ≤0.35 were 27% and 53%, respectively. The predictors of allcause mortality were age （HR 1.34/per increased 10 year, 95% CI 1.01 -1.77 ）, NYHA function class （HR3.17/per increased 1 class, 95% CI 1.94 -5.19） and the stage of chronic kidney disease （HR 1.85/per increased 1 stage, 95% CI 1.12 - 3.05 ）, as well as beta-blockers （ HR 0. 38, 95% CI 0. 15 - 0.93） and statins （HR 0.44, 95% CI 0.22 - 0.88） at discharge after adjusted multiple factors. Conclusion The majority of chronic heart failure patients with reduced ejection fraction take the medications recommended by the guidelines. However, the prognosis is poor, especially for the patient with LVEF≤0.35. D-blockers and statins can improve the prognosis.