舒比替-缬沙坦与血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂在心力衰竭和射血分数小于60 %患者中的临床结果：一项回顾性、观察性、平行队列、多组研究

IF 2.6 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung Pub Date : 2025-05-01 DOI:10.1016/j.hrtlng.2025.04.027

Nancy M. Albert , James F. Bena , Shannon L Morrison , J. Bradley Williams , Kathleen Faulkenberg , Rahul Khairnar , Trejeeve Martyn

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引用次数: 0

摘要

现实世界心衰（HF）和全因住院、HF相关急诊就诊、全因死亡率以及全因或HF住院或HF相关急诊就诊的综合发生率仍然很高，原因是核心HF药物的使用不足。目的：需要更好地了解现实世界的临床结果，基于苏比特-缬沙坦与血管紧张素转换酶抑制剂（ACEI）或血管紧张素II受体阻滞剂（ARB）在HF患者和大范围射血分数中的使用。方法根据年龄、性别、EF、合并症、收缩压和指标日期（医院或门诊），从多中心、多州的医疗保健系统数据库中检索处方沙比替-缬沙坦的患者与ACEI/ARB患者的数据进行匹配。采用线性、logistic和泊松模型对沙比替-缬沙坦与ACEI/ARB的6个月和12个月疗效进行评估。结果患者(N = 4188；2094名/队列)根据特征匹配良好；29.8 %为女性，平均（SD）年龄64.3（13.1）岁，收缩压122.0 (16.2)mmHg， EF%为29.1 (9.9)；近半数为NYHA FC II型，422例（10.1 %）EF为41-60 %。基线时非研究药物的使用频率为-受体阻滞剂92.6% %，矿皮质激素受体拮抗剂43.2% %，利尿剂64.2% %。与ACEI/ARB相比，使用苏比替-缬沙坦的患者6个月和12个月的临床结果均得到改善（12个月p<； 0.001）。结论：在HF和EF高达60% %的患者中，使用苏比替-缬沙坦可降低12个月的发病率和死亡率。提供者和临床医生需要根据分级肾素血管紧张素系统抑制剂国家指南建议，倡导使用苏比特-缬沙坦。

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Clinical outcomes of sacubitril-valsartan versus angiotensin converting enzyme inhibitor or angiotensin receptor blocker among patients with heart failure and ejection fraction at/less than 60 %: A retrospective, observational, parallel cohort, multi-group study

Background

Real-world heart failure (HF) and all-cause hospitalization, HF-related emergency care visits, all-cause mortality and the composite of all-cause or HF hospitalization or HF-related emergency visit remain high, due to underuse of core HF medications.

Objectives

A better understanding of real-world clinical outcomes is needed based on sacubitril-valsartan vs. angiotensin converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) use among patients with HF and a wide range of ejection fractions.

Methods

Data retrieved from a multi-center, multi-state healthcare system database of patients prescribed sacubitril-valsartan were matched to those on ACEI/ARB based on age, sex, EF, comorbidity status, systolic blood pressure and index date site (hospital or ambulatory). Six- and 12-month outcomes based on sacubitril-valsartan vs. ACEI/ARB were assessed using linear, logistic, and Poisson models with generalized estimating equations.

Results

Patients (N = 4188; 2094/cohort) were well matched based on characteristics; 29.8 % were female, mean (SD) age was 64.3 (13.1) years, systolic blood pressure was 122.0 (16.2) mmHg, EF% was 29.1 (9.9); nearly half were in NYHA FC II and 422 (10.1 %) had EF of 41–60 %. Frequency of non-study medications at baseline was 92.6 % beta-blocker, 43.2 % mineralocorticoid receptor antagonist and 64.2 % loop diuretic. Compared to ACEI/ARB, all 6 and 12-month clinical outcomes were improved among patients using sacubitril-valsartan (all 12-month p<.001).

Conclusions

Among patients with HF and EF up to 60 %, sacubitril-valsartan use was associated with lower 12-month morbidity and mortality. Providers and clinicians need to advocate for use of sacubitril-valsartan per hierarchical renin angiotensin system inhibitor national guideline recommendations.

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来源期刊

Heart & Lung 医学-呼吸系统

CiteScore

4.60

自引率

3.60%

发文量

184

审稿时长

35 days

期刊介绍： Heart & Lung: The Journal of Cardiopulmonary and Acute Care, the official publication of The American Association of Heart Failure Nurses, presents original, peer-reviewed articles on techniques, advances, investigations, and observations related to the care of patients with acute and critical illness and patients with chronic cardiac or pulmonary disorders. The Journal''s acute care articles focus on the care of hospitalized patients, including those in the critical and acute care settings. Because most patients who are hospitalized in acute and critical care settings have chronic conditions, we are also interested in the chronically critically ill, the care of patients with chronic cardiopulmonary disorders, their rehabilitation, and disease prevention. The Journal''s heart failure articles focus on all aspects of the care of patients with this condition. Manuscripts that are relevant to populations across the human lifespan are welcome.