Mi-Hyang Jung, Dong-Hyuk Cho, Jimi Choi, Mi-Na Kim, Chan Joo Lee, Jung-Woo Son, Yaeni Kim, Jong-Chan Youn, Byung-Su Yoo
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The primary endpoint was a composite of all-cause mortality and any hospitalization. Secondary endpoints included all-cause mortality, any hospitalization and cardiovascular mortality. During a median follow-up of 19.1 months, ARNI use was associated with a significantly lower risk of the primary endpoint (hazard ratio [HR] 0.86, 95% confidence interval [CI] 0.75–0.97) compared with RAS blockers. ARNI also showed a reduced risk of all-cause mortality (HR 0.68, 95% CI 0.54–0.86), any hospitalization (HR 0.86, 95% CI 0.75–0.98) and cardiovascular mortality (HR 0.68, 95% CI 0.52–0.89). Subgroup analyses demonstrated consistent associations across age, sex, comorbidities and medications. 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引用次数: 0
摘要
目的:血管紧张素受体-neprilysin抑制剂(ARNI)治疗可改善心力衰竭伴射血分数降低(HFrEF)的预后。然而,它对接受替代治疗的合并肾衰竭患者的益处仍不确定。方法和结果:使用国家健康保险服务数据库,我们确定了在2017年至2021年期间服用ARNI或肾素-血管紧张素系统(RAS)阻滞剂的HFrEF和肾衰竭患者接受替代治疗。在应用治疗加权逆概率后,我们比较了2104例ARNI患者和2191例RAS受体阻滞剂患者。主要终点是全因死亡率和住院率的综合。次要终点包括全因死亡率、住院率和心血管死亡率。在19.1个月的中位随访期间,与RAS阻滞剂相比,ARNI的使用与主要终点的风险显著降低相关(风险比[HR] 0.86, 95%可信区间[CI] 0.75-0.97)。ARNI还显示全因死亡率(HR 0.68, 95% CI 0.54-0.86)、任何住院(HR 0.86, 95% CI 0.75-0.98)和心血管死亡率(HR 0.68, 95% CI 0.52-0.89)的风险降低。亚组分析显示,年龄、性别、合并症和药物之间存在一致的关联。良好的ARNI依从性与较低的主要结局风险相关,而不依从性则没有任何益处。结论:在接受替代治疗的HFrEF肾衰竭患者中,与RAS阻滞剂相比,ARNI的使用与全因死亡率、住院率和心血管死亡率的风险较低相关,特别是在那些治疗依从性良好的患者中。
Angiotensin receptor-neprilysin inhibitors in concurrent heart failure with reduced ejection fraction and kidney failure
Aims
Angiotensin receptor-neprilysin inhibitor (ARNI) therapy has demonstrated improved outcomes in heart failure with reduced ejection fraction (HFrEF). However, its benefits in patients with concomitant kidney failure undergoing replacement therapy remain uncertain.
Methods and results
Using the National Health Insurance Service database, we identified individuals with HFrEF and kidney failure receiving replacement therapy who were prescribed either ARNI or renin-angiotensin system (RAS) blockers between 2017 and 2021. After applying inverse probability of treatment weighting, we compared 2104 patients on ARNI with 2191 on RAS blockers. The primary endpoint was a composite of all-cause mortality and any hospitalization. Secondary endpoints included all-cause mortality, any hospitalization and cardiovascular mortality. During a median follow-up of 19.1 months, ARNI use was associated with a significantly lower risk of the primary endpoint (hazard ratio [HR] 0.86, 95% confidence interval [CI] 0.75–0.97) compared with RAS blockers. ARNI also showed a reduced risk of all-cause mortality (HR 0.68, 95% CI 0.54–0.86), any hospitalization (HR 0.86, 95% CI 0.75–0.98) and cardiovascular mortality (HR 0.68, 95% CI 0.52–0.89). Subgroup analyses demonstrated consistent associations across age, sex, comorbidities and medications. Good adherence to ARNI was linked to a lower risk of the primary outcome, whereas non-adherence showed no benefit.
Conclusions
Among HFrEF patients with kidney failure receiving replacement therapy, ARNI use was associated with lower risks of all-cause mortality, any hospitalization and cardiovascular mortality compared with RAS blockers, particularly in those with good adherence to therapy.
期刊介绍:
ESC Heart Failure is the open access journal of the Heart Failure Association of the European Society of Cardiology dedicated to the advancement of knowledge in the field of heart failure. The journal aims to improve the understanding, prevention, investigation and treatment of heart failure. Molecular and cellular biology, pathology, physiology, electrophysiology, pharmacology, as well as the clinical, social and population sciences all form part of the discipline that is heart failure. Accordingly, submission of manuscripts on basic, translational, clinical and population sciences is invited. Original contributions on nursing, care of the elderly, primary care, health economics and other specialist fields related to heart failure are also welcome, as are case reports that highlight interesting aspects of heart failure care and treatment.