降低排泄率的心脏衰竭的药理治疗:更新的系统审查和网络元分析
Bart J van Essen1, Daan C H Ceelen1, Wouter Ouwerkerk2
1Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Journal of the American College of Cardiology
|September 2, 2025
概括
更新的分析证实,四重疗法 (ARNi,β阻塞剂,MRA,SGLT2i) 显著降低了心力衰竭的死亡率. 添加发射剂可能会有进一步的生存益处.
科学领域:
- 心脏病学
- 药理学
- 临床试验
背景情况:
- 之前的元分析发现,对HFrEF死亡率来说,四重治疗 (β- 阻断剂,ARNi,MRA,SGLT2i) 是最佳的.
- 这项研究结合了最近的随机对照试验 (RCT),包括VICTOR试验,以更新治疗疗效.
研究的目的:
- 对HFrEF患者不同药物治疗方案的有效性进行比较.
- 评估添加输送对标准HFrEF处理的影响.
主要方法:
- 在HFrEF中对MEDLINE,EMBASE和Cochrane CENTRAL的RCT进行系统文献搜索至2025年4月.
- 频率网络元分析以估计死亡率和发病率的危险比率.
- 使用队列数据量化绝对生存益处 (BIOSTAT-CHF,ASIAN-HF).
主要成果:
- 分析了89个涉及103,754名患者的RCT.
- 五重疗法 (ARNi,β- 阻断剂,MRA,SGLT2i, vericiguat) 显示出所有原因死亡率的最大降低 (HR 0. 35).
- 四倍治疗 (ARNi,β- 阻断剂,MRA,SGLT2i) 预计可增加5. 3年的寿命,而五倍治疗可增加70岁患者的寿命6. 0年的寿命.
结论:
- 四次治疗仍然是降低HFrEF患者死亡率和发病率的高效方案.
- 添加到四重治疗时,Vericiguat可能会提供适度的增量存活率,但需要进一步的研究.
- 这些发现强化了对HFrEF患者的指导医学治疗的好处.
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