心不全患者の継続的な薬物療法の重要性(Continued Medication Important for Heart Failure Patients)

ad

2025-03-17 カロリンスカ研究所(KI)

©m-sato@tii

カロリンスカ研究所の研究者らは、心不全患者が薬物療法を継続することの重要性を強調しています。特に、アンジオテンシン変換酵素(ACE)阻害薬やアンジオテンシンII受容体拮抗薬(ARB)のようなレニン-アンジオテンシン系阻害薬は、心不全の進行を遅らせ、患者の生存率を向上させる効果があります。しかし、これらの薬剤は腎機能に影響を及ぼす可能性があり、一部の患者は腎機能の低下を理由に投薬を中止することがあります。研究者らは、腎機能の軽度から中等度の低下が見られる場合でも、これらの薬剤の継続が患者の予後を改善する可能性が高いと指摘しています。したがって、医療従事者は患者の腎機能を慎重に監視しながら、可能な限り薬物療法を継続することが推奨されます。

<関連情報>

心不全患者におけるガイドライン指示の内科的治療の中止と駆出率の改善 Withdrawal of Guideline-Directed Medical Therapy in Patients With Heart Failure and Improved Ejection Fraction

Christian Basile, MD, Felix Lindberg, MD, PhD, Lina Benson, MSc, Federica Guidetti, MD, Ulf Dahlström, MD, PhD, Massimo Francesco Piepoli, MD, PhD, Peter Mol, PharmD, PhD, Raffaele Scorza, MD, PhD, Aldo Pietro Maggioni, MD, Lars H. Lund, MD, PhD, and Gianluigi Savarese, MD, PhD
Circulation  Published: 17 March 2025
DOI:https://doi.org/10.1161/CIRCULATIONAHA.124.072855

Abstract

BACKGROUND:
Limited evidence exists on the prognostic role of continuing medical therapy in patients with heart failure (HF) and an ejection fraction (EF) that has improved over time. This study assessed rates of, patient profiles, and associations with morbidity/mortality of renin-angiotensin inhibitors (RASi), angiotensin receptor–neprilysin inhibitors (ARNi), beta-blockers (BBL), and mineralocorticoid receptor antagonists (MRA) withdrawal in patients with HF with improved EF.

METHODS:
Patients with a first recorded EF <40% and a later EF ≥40% from the Swedish HF registry between June 11, 2000, and December 31, 2023, were included in this retrospective observational study. Withdrawal was defined as a patient on treatment at the first (reduced) but not at the second (improved) registration. The association between withdrawal and time to first cardiovascular mortality/hospitalization for HF with censoring at 1 year was assessed by Cox regression model using overlap weighting.

RESULTS:
Of 8728 patients with HF with improved EF (median age, 70 years [25th to 75th percentile, 61–78], 2611 [29.9%] women), 96%, 94%, and 46% received RASi/ARNi, BBL, and MRA, respectively, when EF was <40%. The withdrawal rates at the time of the improved EF registration were 4.4% for RASi/ARNi, 3.3% for BBL, and 17.2% for MRA. Predictors of withdrawal included lower use of other HF medications, higher EF at the later EF registration, and a longer time between the 2 EF assessments. After weighting, withdrawal was independently associated with a higher risk of cardiovascular mortality/hospitalization for HF by 38% for RASi/ARNi and 36% for MRA, but not for BBL. Withdrawal of BBL was associated with a higher risk of the primary outcome in the subgroup of patients with an improved EF of 40% to 49% versus ≥50% (P-interaction 0.03).

CONCLUSIONS:
In patients with HF with improved EF, HF therapy withdrawal was rare. Withdrawing RASi/ARNi and MRA was associated with higher mortality/morbidity at 1 year. No association was found for BBL withdrawal, albeit with a significant heterogeneity for EF at improvement, suggesting better outcomes with continuing BBL only until EF improves up to 50%. These results are hypothesis-generating and highlight the need for randomized controlled trials testing BBL withdrawal in patients with HF with improved EF.

医療・健康
ad
ad
Follow
ad
タイトルとURLをコピーしました