射血分数降低的心力衰竭合并慢性阻塞性肺疾病药物治疗现状

Drug Treatment for Heart Failure with Reduced Ejection Fraction and Chronic Obstructive Pulmonary Disease:a Retrospective Analysis

背景射血分数降低的心力衰竭(HFrEF)和慢性阻塞性肺疾病(COPD)常合并发生,两者共存时可引起住院次数增加、经济负担加重、病情恶化及死亡率上升等一系列问题。目的了解COPD在HFrEF患者中的发生率,调查该类患者的用药情况。方法选取2017年在昆明医科大学第一附属医院心内科住院、美国纽约心脏病协会(NYHA)分级为Ⅱ～Ⅳ级的CHF患者238例。根据是否合并COPD,分为HFrEF+COPD组(n=26)和HFrEF组(n=212)。收集两组的临床资料,对比分析两组用药情况、β-受体阻滞剂(BBs)使用情况及静息心率管理状况。结果 238例HFrEF患者中,合并COPD者26例,占10.9%。HFrEF+COPD组患者BBs、醛固酮受体拮抗剂(MRAs)使用率低于HFrEF组,抗血小板类药物使用率高于HFrEF组(P<0.05);两组血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂(ACEI/ARB)、利尿剂、地高辛、他汀类药物使用率比较,差异无统计学意义(P>0.05)。两组琥珀酸美托洛尔、比索洛尔、酒石酸美托洛尔、卡维地洛的使用率和平均使用剂量比较,差异无统计学意义(P>0.05)。HFrEF组,使用琥珀酸美托洛尔、比索洛尔、酒石酸美托洛尔、卡维地洛达靶剂量50%以上但未达靶剂量者分别为5例(2.4%)、20例(9.4%)、10例(4.7%)、1例(0.5%),仅使用比索洛尔时2例(0.9%)患者达靶剂量;HFrEF+COPD组,使用琥珀酸美托洛尔、比索洛尔、酒石酸美托洛尔、卡维地洛达靶剂量50%以上但未达靶剂量者分别为0例、2例(7.7%)、0例、1例(3.8%),无达靶剂量者。HFrEF组,静息心率55～60、61～70、>70次/min者分别为7例(3.3%)、75例(35.4%)、129例(60.8%),HFrEF+COPD组,静息心率55～60、61～70、>70次/min者分别为2例(7.7%)、10例(38.5%)、14例(53.8%)。两组静息心率比较,差异无统计学意义(P>0.05)。结论 HFrEF患者合并COPD较常见,两组BBs均有使用,但使用率和剂量有待改善,且两组静息心率管理的达标率也较低,未来应对HFr EF+COPD的诊断和治疗给予足够的关注。

Background Heart failure with reduced ejection fraction(HFrEF) often coexists with chronic obstructive pulmonary disease(COPD),which leads to a series of problems such as increased hospitalization rate,higher financial burden,worsening conditions and raised mortality.Objective To examine the incidence of COPD in HFrEF,and to investigate the drug treatment for HFrEF with COPD.Methods We recruited 238 hospitalized patients with HFrEF and NYHA class Ⅱ-Ⅳ from Cardiovascular Department,First Affiliated Hospital of Kunming Medical University,including 26 with COPD(HFrEF+COPD group) and 212 without(HFrEF group) in 2017.We comparatively analyzed both groups' general personal data,drug treatment including the use of β-blockers(BBs) and resting heart rate management.Results The prevalence of COPD in the patients was 10.9%(26/238).HFrEF+COPD group had lower rates of using BBs,and mineralocorticoid receptor antagonists(MRAs),but higher rate of using antiplatelet drugs compared with HFrEF group(P<0.05).Both groups had no significant differences in the rates of using angiotensin-converting enzyme inhibitors(ACEI)/ angiotensin-receptor blockers(ARB),diuretics,digoxin and statins(P>0.05).The rates of using metoprolol succinate,bisoprolol,metoprolol tartrate and carvedilol and the average total cumulative dose of each of these drugs showed no significant differences between the groups(P>0.05).In the HFrEF group,the rates of using over 50% of the target dose but less than the target dose of metoprolol succinate,bisoprolol,metoprolol tartrate,and carvediloda were 2.4%(5/212),9.4%(20/212),4.7%(10/212),0.5%(1/212),respectively.And only 0.9%(2/212) used the target dose of bisoprolol.In the HFrEF +COPD group,the rates of using over 50% of the target dose but less than the target dose of metoprolol succinate,bisoprolol,metoprolol tartrate,and carvediloda were 0,7.7%(2/26),0,and 3.8%(1/26),respectively.No one used the targer dose of each of these drugs during treatment.The rates of having a resting heart rate of 55-60,61-70,and over 70 beats per minute were 3.3%(7 cases),35.4%(75 cases) and 60.8%(129 cases),respectively,in the HFrEF group,and 7.7%(2 cases),38.5%(10 cases) and 53.8%(14 cases) in HFrEF+COPD group,indicating no obvious differences between the groups(P>0.05).Conclusion The prevalence of COPD was high in HFrEF patients.BBs were used in HFrEF patients with or without COPD,but the use rate and dose are to be improved.Moreover,the rates of meeting the target resting heart rate were low in both groups.Therefore,more attention should be paid to the diagnosis and treatment of HFrEF with COPD.