乙型阻斷劑於併有心房顫動和心臟衰竭病人效果比較

Abstract

研究背景： 研究顯示部分beta blocker(BB)的使用能有效改善心臟衰竭（HF: heart failure）病人的存活率。同時，BB在心房顫動（AF: atrial fibrillation）病人的心速控制上亦佔有重要的地位。但是目前對於不同的BB在心房顫動併有心衰竭病人上具有的治療效果仍未有充分的探究。 研究目的： 針對使用不同BB的AF病人進行效果評估。並且進一步分析病人共病HF與否於BB使用的效果是否有所差異。 研究方法： 本研究為回溯性世代研究（retrospective cohort study），以2005-2011年的臺灣健康保險資料庫做為資料來源，篩選AF病人並依病人之前是否有HF紀錄做分組。之後再依病人所使用之BB做分組並挑選出使用bisoprolol、carvedilol以及metoprolol的病人做為主要研究族群。為了減少選擇性偏差，因此本研究利用傾向分數（propensity score）進行比較組間的配對，建構類似隨機分派對照實驗（randomized controlled trial），再以Cox proportional hazards regression model進行結果分析。 研究結果 在AF病人中，使用carvedilol的病人相較於使用bisoprolol的病人，有統計上顯著較高的因心血管疾病而再入院的風險。（HR 1.12; 95% CI 1.03 to 1.22; P=0.0062）。而此結果在AF未併有HF的病人上同樣顯著（HR 1.19; 95% CI 1.02 to 1.39; P=0.0242）。但在AF併有HF的病人上雖趨勢相同但並不顯著（HR 1.02; 95% CI 0.92 to 1.13; P=0.6998）。 結論 於AF病人使用carvedilol可能使病人較使用bisoprolol有較高的因心血管疾病再入院的風險。顯示不同的BB可能有不同的效果且此效果的顯著與否會隨著病人的HF共病而有所不同。

Background It has been proven that the usage beta-blocker (BB) can improve the mortality of heart failure (HF) patients. Meanwhile, BB plays a vital role in rate control of atrial fibrillation (AF) patients. Nevertheless, there hasn’t sufficient investigation toward the effects of individual BB on AF patients combined with HF. Purpose To assess the effects for AF patients who used different BB. In addition, examing whether HF comorbidity will affect the results is the other aim. Methods This study is a retrospective cohort study based on National Health Insurance Research Database (NHIRD) from 2005 to 2011. AF patients are included and divided to with HF group and without HF group. The further classification is based on records of BB usage. Patients used bisoprolol, carvedilol and metoprolol are the main population this study focus on. To reduce selection bias, propensity score is applied to match comparison group. The results are assessed after constructing groups similar to randomized controlled trial.

Results Compared carvedilol with bisoprolol, the application of carvedilol shows higher risk of re-hospitalization of cardiovascular events in AF patients (HR 1.12; 95% CI 1.03 to 1.22; P=0.0062). This result is similar in the subgroup which AF patients without HF(HR 1.19; 95% CI 1.02 to 1.39; P=0.0242). Nonetheless, in AF patients combined with HF, the difference isn’t significant (HR 1.02; 95% CI 0.92 to 1.13; P=0.6998). Conclusion The effects of BB may be varied from one to another. Patients applied bisoprolol seems to have lower risk on the happening of cardiovascular re-hospitalization compared with patients used carvedilol in AF patients. This results may differ because of comorbidity of HF.