| 【 Objective 】 Heart failure(HF)is a severe or end-stage manifestation of various cardiovascular diseases.It is one of the two epidemics in the cardiovascular field in the21 st century.It has a high mortality rate and rehospitalization rate.Affect the quality of life and prognosis of patients.At present,finding new intervention targets to achieve comprehensive management of HF and improving the quality of life and prognosis of HF patients has become one of the hot research fields.Studies have shown that increased heart rate is an independent risk factor for the prognosis of HF patients and has become a new target for HF management.As a sympathetic nervous system antagonist,β-blockers have been recommended by HF guidelines at home and abroad,and it is recommended to use it as soon as possible to inhibit left ventricular remodeling,reduce mortality and rehospitalization rate in HF patients,improve quality of life,and prolong survival.However,due to the negative inotropic effect of β-blockers and the effect of lowering blood pressure and airway resistance,the following clinical conditions limit the beta failure of the beta-blockers in(heart failure with reduced ejection fraction,HFr EF)Early heart rate control after admission to hospital,including early stage of instability after HF patients admitted to hospital,low blood pressure and bronchial asthma attack;In addition,no previous use of beta blockers requires starting from a small dose doubling the dose every 2 to 4 weeks to achieve the recommended target dose or the maximum tolerable dose for the guideline;Patients who are using beta blockers may need to reduce beta receptors after hospitalization due to increased heart failure.The dose of the blocker is even discontinued,so that the heart rate of HF patients can not be effectively controlled early.Based on the above reasons,the current clinical use of β-blockers is low,which makes the early heart rate control of patients with HFr EF after admission unsatisfactory,which seriously affects the prognosis of patients with heart failure.Therefore,it is very important to explore the safety and effective control measures of early heart rate in patients with HF.As a new drug,ivabradine is a specific channel inhibitor of sinus node,which has a slowing heart rate and does not affect myocardial contractility and blood pressure.This prospective case randomized controlled trial was conducted to compare the effects of early ivabradine regimen with early beta blocker regimens on early heart rate control and short-term prognosis in patients with HFr EF after admission.【Method】Selected from November 2017 to January 2019 in the People’s Liberation Army Joint Service Support Unit 967 Hospital(formerly the 210 th Hospital of the People’s Liberation Army)hospitalized for acute heart failure(initial heart failure or increased heart failure),in line with the inclusion criteria [ejection score(EF)≤ 40%),3hours after admission,ECG monitoring for sinus rhythm,resting heart rate after routine treatment ≥ 80 beats / min,without cardiogenic shock,hypotension(systolic blood pressure ≤ 95 mm Hg)and chronic A total of 45 patients with acute exacerbation of obstructive pulmonary disease(COPD).The patients were randomly divided into the ivabradine group(test group,n=25 cases)and the β-blocker group(control group,n=20cases).The observations were recorded at the time of admission and on the first day after grouping.Resting heart rate at 3 days and 7 days,heart function classification of New York Heart Association(NYHA),brain natriuretic peptide(NT-pro BNP)value,adverse drug reaction within 7 days,EF value on day 30,NYHA cardiac function,The main adverse cardiovascular events(MACE),including all-cause death,cardiac death,and heart failure rehospitalization rate,were not lost to follow-up during the follow-up period,and the data were statistically analyzed.【 Result】 1 、The basic data of the experimental group and the control group were compared: age(years)(67.0±7.7vs..68.8±7.5,P=0.405),gender(% male)(76% vs.75%,P=1.00),3 hours after admission Resting heart rate(times/min)(96.8±7.3vs.96.5±5.3,P=0.128),smoking(%)(28% vs.45%,P=0.236),hyperlipidemia(%)(12% vs.20%,P=0.748),hypertension(%)(60% vs.70%,P=0.486),diabetes(%)(44% vs.65%,P=0.161),coronary heart disease(%)(80% vs.85%,P=0.965)Valvular disease(%)(8% vs.0%,P=0.495),cardiomyopathy,etc.(%)(24% vs.30%,P=0.651),NYHA cardiac function II(%)(12% vs.15%,P= 1.000),NYHA class III(%)(40% vs.50%,P=0.502),NYHA class IV(%)(48% vs.35%,P=0.380),NT-pro BNP value(pg/l)(14097.6±8823.5vs.14135.7±7846.5,P=0.135),EF 值(%)(34.0±5.3vs.34.4±5.3,P = 0.092).basic treatments including ACEI/ARB(%)(72% vs.80%,P=0.786),shakuba valsartan(%)(16% vs.5%,P= 0.491),diuretic(%)(84% vs.95%,P = 0.491),MRA(%)(88% vs.90%,P = 1.000),deacetyl geranin(%)(64%vs.80%,P = 0.398),antiplatelet drugs(%)(92%)vs.95%,P=0.770),lipid-lowering drugs(%)(84% vs.90%,P=0.883),vasodilator drugs(%)(48% vs.55%,P=0.641),the above basic data were not statistically significant,P value>0.05.2 、 Comparison of primary endpoints between the experimental group and the control group: no MACE events occurred in the two groups after 30 days of follow-up.3、The experimental group and the control group were compared with the secondary endpoints: resting heart rate(times/min)on the 1st after group treatment(83.9±9.5vs.84.5±9.6,P=0.101).There was no significant difference between the two groups.The heart rate(times/min)(71.8±6.1 vs.71.3±7.3,P=0.029),the difference between the two groups was statistically significant,and the resting heart rate(time/min)on the 7th day(66.3 ± 5.1 vs.67.37±4.3,P = 0.000),the difference between the two groups was statistically significant.The 7D and 30 d NYHA cardiac function grades improved above grade 2(%)(36% vs.5%,P=0.034)(56% vs.15%,P=0.012).The difference between the two groups was statistically different.(%)(40% vs.50%,P=0.502)(36% vs.45%,P=0.540),there was no significant difference between the two groups,no improvement or worsening(%)(24% vs.45%),P = 0.138)(8% vs.40%,P= 0.027).NT-pro BNP values at 1d and 7d(10416.4±5455.8vs.10407.7±5873.9,P=0.670),there was no significant difference between the two groups(6092.4±4570.7vs.7031.3±4047.9,P=0.000),both groups had Significant differences.The 7d and 30 d EF values(%)(34.1±5.4vs.34.6±5.5,P=0.076)were not statistically significant(40.9±6.3vs.40.1±8.4,P=0.037).Statistical significance.The average length of hospital stay(10.5 ± 3.3 vs.11.3± 2.9,P = 0.012),the difference between the two groups was statistically significant.4、Comparison of safety indexes between the experimental group and the control group:adverse drug reactions within 7 days included aggravation of heart failure(%)(4% vs.15%,P=0.446)and hypotension(%)(8% vs.20%,P=0.462),no adverse reactions such as new-onset atrial fibrillation,dizziness,headache,and phoenix were found in the two groups.The above adverse reactions did not occur after 30 days of follow-up.【Conclusion】1.Early use of ivabradine to control heart rate in patients with HFr EF was more effective in achieving early heart rate management,improving clinical symptoms,and shortening hospital stay than using beta blocker,but there was no significant improvement in short-term prognosis.2.The early use of ivabradine to control heart rate in patients with HFr EF was safe and effective. |
PDF Full Text Request