β-阻断剂可改善心衰病人的各项指标
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sourceJAMA
WESTPORT, Mar 08 (Reuters Health) - Already shown to lower total mortality by more than one third in patients with heart failure, the controlled-release/extended release beta-blocker metoprolol succinate (metoprolol CR/XL) also reduces hospitalizations due to worsening heart failure and improves symptoms.
Those findings come from the Metoprolol CR/XL Randomized Intervention Trial in Congestive Heart Failure (MERIT-HF), a study conducted at 313 sites in the United States and 13 European countries by Dr. Bjorn Fagerberg of Sahlgrenska University Hospital in Gothenburg, Sweden, and colleagues. The trial included 3,991 patients who had symptomatic chronic heart failure and decreased ejection fraction.
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After a 2-week placebo run-in period, patients were randomized to receive either 25 or 12.5 mg of metoprolol CR/XL or placebo once daily. The dose was gradually increased to 200 mg daily if tolerated.
As Reuters Health reported last March, MERIT-HF was stopped at the halfway point when interim analysis indicated that the treatment group had a statistically significant 34% reduction in total mortality. In The Journal of the American Medical Association for March 8, the researchers provide more extensive analysis, reporting that "metoprolol CR/XL significantly reduced all combined endpoints...compared with placebo."
, 百拇医药
All-cause mortality or hospitalizations were 19% lower in the treatment group than in the placebo group, the researchers report. Deaths or hospitalizations due to worsening heart failure were 31% lower in the treatment group. In addition, patients in the treatment group had a 32% lower risk of death or heart transplantation and a 39% lower risk of cardiac death or nonfatal myocardial infarction.
The researchers report a statistically significant improvement in physician-assessed NYHA functional class in the treatment group compared with the placebo group. Also, more patients receiving the beta-blocker reported improvements in symptoms and well-being.
, 百拇医药
The medication was well tolerated, according to the report. Withdrawal from the study was 10% lower in the treatment group than in the placebo group for all causes and 25% lower for worsening heart failure.
Since beta-blockers are relatively inexpensive compared with hospitalization, the substantial reduction in time spent hospitalized for worsening heart failure "suggests a positive effect on healthcare costs with metoprolol CR/XL treatment in patients with chronic heart failure," the authors write.
, 百拇医药
In an editorial that accompanies the study, Dr. Robert M. Califf and Dr. Christopher M. O’Connor, cardiologists at Duke University Medical Center in Durham, North Carolina, point out that several issues remain unresolved, despite the encouraging findings.
The study demonstrated beneficial effects of metoprolol CR/XL in the elderly and in patients with NYHA class IV heart failure, "but the relatively wide confidence intervals, coupled with less positive results in other trials, leaves uncertainty about whether the early hazard of treatment in this population may outweigh the potential for benefit in these high-risk subgroups," they write.
, 百拇医药
The editorialists also note that more attention needs to be paid to the adverse effects of beta-blockers, both in the first few weeks of therapy and in the long term.
In spite of these reservations, however, Drs. Califf and O’Connor conclude that "given the overwhelming evidence of the benefit of beta-blockers in patients with heart failure from this study and others, the current status of adopting this treatment into clinical practice must be examined."
In comments to Reuters Health, Dr. Goldstein called the use of beta-blockers to treat heart failure "a major paradigm shift in our therapy." While most cardiologists are familiar with the benefits of the medications in these patients, Dr. Goldstein said, "it’s a little bit harder sell" for primary care physicians., 百拇医药
Those findings come from the Metoprolol CR/XL Randomized Intervention Trial in Congestive Heart Failure (MERIT-HF), a study conducted at 313 sites in the United States and 13 European countries by Dr. Bjorn Fagerberg of Sahlgrenska University Hospital in Gothenburg, Sweden, and colleagues. The trial included 3,991 patients who had symptomatic chronic heart failure and decreased ejection fraction.
, http://www.100md.com
After a 2-week placebo run-in period, patients were randomized to receive either 25 or 12.5 mg of metoprolol CR/XL or placebo once daily. The dose was gradually increased to 200 mg daily if tolerated.
As Reuters Health reported last March, MERIT-HF was stopped at the halfway point when interim analysis indicated that the treatment group had a statistically significant 34% reduction in total mortality. In The Journal of the American Medical Association for March 8, the researchers provide more extensive analysis, reporting that "metoprolol CR/XL significantly reduced all combined endpoints...compared with placebo."
, 百拇医药
All-cause mortality or hospitalizations were 19% lower in the treatment group than in the placebo group, the researchers report. Deaths or hospitalizations due to worsening heart failure were 31% lower in the treatment group. In addition, patients in the treatment group had a 32% lower risk of death or heart transplantation and a 39% lower risk of cardiac death or nonfatal myocardial infarction.
The researchers report a statistically significant improvement in physician-assessed NYHA functional class in the treatment group compared with the placebo group. Also, more patients receiving the beta-blocker reported improvements in symptoms and well-being.
, 百拇医药
The medication was well tolerated, according to the report. Withdrawal from the study was 10% lower in the treatment group than in the placebo group for all causes and 25% lower for worsening heart failure.
Since beta-blockers are relatively inexpensive compared with hospitalization, the substantial reduction in time spent hospitalized for worsening heart failure "suggests a positive effect on healthcare costs with metoprolol CR/XL treatment in patients with chronic heart failure," the authors write.
, 百拇医药
In an editorial that accompanies the study, Dr. Robert M. Califf and Dr. Christopher M. O’Connor, cardiologists at Duke University Medical Center in Durham, North Carolina, point out that several issues remain unresolved, despite the encouraging findings.
The study demonstrated beneficial effects of metoprolol CR/XL in the elderly and in patients with NYHA class IV heart failure, "but the relatively wide confidence intervals, coupled with less positive results in other trials, leaves uncertainty about whether the early hazard of treatment in this population may outweigh the potential for benefit in these high-risk subgroups," they write.
, 百拇医药
The editorialists also note that more attention needs to be paid to the adverse effects of beta-blockers, both in the first few weeks of therapy and in the long term.
In spite of these reservations, however, Drs. Califf and O’Connor conclude that "given the overwhelming evidence of the benefit of beta-blockers in patients with heart failure from this study and others, the current status of adopting this treatment into clinical practice must be examined."
In comments to Reuters Health, Dr. Goldstein called the use of beta-blockers to treat heart failure "a major paradigm shift in our therapy." While most cardiologists are familiar with the benefits of the medications in these patients, Dr. Goldstein said, "it’s a little bit harder sell" for primary care physicians., 百拇医药