在心力衰竭患者中使用 midodrine 的安全性:一项追溯队列研究
Ming-Ju Wu1,2, Cheng-Hsu Chen1,2,3,4, Shang-Feng Tsai1,2,3
1Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.
Frontiers in pharmacology
|March 21, 2024
概括
在心力衰竭患者中使用米多林,减少了急诊室的访问,但增加了呼吸衰竭,重症监护室的入院,住院和死亡的风险. 进一步的研究是必不可少的,以澄清其作用.
科学领域:
- 心脏病学 心脏病学
- 药理学 药理学是指药理学的学科.
- 临床研究 临床研究
背景情况:
- 减少喷射分数 (HFrEF) 的心力衰竭带来了重大的临床挑战和风险.
- 对于HFrEF患者的血压管理中Midodrine的安全性,需要进行彻底的调查.
- 这项研究使用了强大的匹配分析来解决HFrEF中midodrine的安全性.
研究的目的:
- 评估诊断为HFrEF的患者中多德林的安全性和相关风险.
- 分析midodrine对关键临床结果的影响,包括死亡率和住院病例.
主要方法:
- 这是一项大规模的队列研究,涉及HFrEF患者 (LVEF<50%),不包括患有恶性瘤或透析患者.
- 倾向性得分匹配 (PSM) 用于创建可比的群体,用于中素使用者和非使用者.
- 评估的结果包括死亡率,晚期慢性病 (CKD),急诊室 (ER) 访问,重症监护室 (ICU) 入院,住院和呼吸衰竭.
主要成果:
- 米多德林的使用与急诊室访问的显著减少有关 (HR:0.77,95% CI:0.71-0.83).
- 相反,米多德林与呼吸衰竭 (HR: 1.16),ICU入院 (HR: 1.14),住院 (HR: 1.21) 和死亡率 (HR: 1.09) 的风险增加有关.
- 这些趋势在各种子组中一致,包括不同的年龄组和基线LVEF.
结论:
- 虽然midodrine可能会减少HFrEF患者的ER访问,但它与严重不良事件的风险增加有关.
- 这些发现表明,减少急救诊所和增加呼吸衰竭风险,ICU停留,住院和死亡率之间存在潜在的权衡.
- 需要进一步的研究来阐明米多德林在HFrEF的血液动力学支持中的确切作用,并验证这些安全问题.
相关概念视频
Heart Failure Drugs: β-Blockers
338
β-adrenergic antagonists, commonly known as β-blockers, block the effects of sympathetic neurotransmitters such as noradrenaline (NA) and adrenaline (ADR). They have several beneficial effects in heart failure treatment. They reduce heart rate, the force of contraction, and cardiac muscle relaxation. They also slow the atrial-ventricular conduction rate and raise the threshold for arrhythmias. The concentration of β-blockers determines their effects on bronchodilation,...
338
Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
428
The activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) contributes to cardiac remodeling, and inhibiting the RAAS is a pharmacological target in heart failure management. As a result, neurohumoral modulation is a crucial treatment principle for managing heart failure. This approach involves using medications like ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers, mineralocorticoid receptor antagonists (MRAs), and neutral...
428
Heart Failure Drugs: Diuretics
370
Heart failure and kidney perfusion are interconnected in a complex way. Reduced renal perfusion and venous congestion are two significant factors that contribute to renal dysfunction in heart failure. The kidneys, primarily responsible for fluid balance in the body, are adversely affected due to compromised cardiac output and increased venous pressure. In response to reduced renal perfusion, the kidneys activate neurohumoral mechanisms to restore balance. However, these mechanisms can be...
370
Heart Failure Drugs: Inotropic Agents
584
Positive inotropic agents are commonly used as the first line of treatment for heart failure. One such agent is digoxin, derived from the genus Digitalis, which has been known for centuries but effectively utilized since 1785. However, these cardiac glycosides can have potentially toxic effects due to their mechanism of action, which involves inhibiting Na+/K+-ATPase and increasing contractility. Digoxin is absorbed orally and distributed in various tissues, including the CNS. It has a long...
584
Antiarrhythmic Drugs: Class I Agents as Sodium Channel Blockers
1.4K
Class I antiarrhythmic drugs are used to treat various types of arrhythmias or irregular heart rhythms. These drugs block the sodium (Na+) channels in the cardiac cells, thereby affecting the movement of electrical impulses across the heart. Class I antiarrhythmic drugs are divided into three subgroups: Class IA, Class IB, and Class IC, each with distinct mechanisms of action and effects on the heart.
Class 1A Antiarrhythmic Drugs: These drugs work by moderately blocking sodium channels,...
Class 1A Antiarrhythmic Drugs: These drugs work by moderately blocking sodium channels,...
1.4K
Pathophysiology of Heart Failure
1.6K
Heart failure (HF) is a progressive syndrome involving ventricles that leads to inadequate cardiac output. It can be classified based on location and output or ejection fraction. Ejection fraction (EF) is an essential measurement in the diagnosis and surveillance of HF. Reduced EF corresponds to systolic heart failure (HFrEF). However, HF with preserved ejection fraction (HFpEF) is becoming increasingly prevalent. Also known as diastolic HF, this form of HF is related to aging. The...
1.6K


