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Частота и обоснованность назначения бета-адреноблокаторов у пациентов с хронической сердечной недостаточностью и сохраненной фракцией выброса: анализ динамики данных рандомизированных клинических исследований

https://doi.org/10.18087/cardio.2020.6.n1062

Полный текст:

Аннотация

Цель    Оценить тренд частоты применения бета-адреноблокаторов, а также частоты возможных поводов для их назначения: артериальная гипертония (АГ), фибрилляция предсердий (ФП), ишемическая болезнь сердца (ИБС), инфаркт миокарда (ИМ) среди участников рандомизированных клинических исследований (РКИ), включавших больных с хронической сердечной недостаточностью с сохраненной фракцией выброса (ХСНсФВ).

Материал и методы  Систематический поиск литературы проводили в базах данных PubMed и EMBASE. В исследование включали РКИ фармакологических методов лечения больных с ХСНсФВ, выполненные в период с 1993 по 2019 г. Исследования по оценке эффективности бета-адреноблокаторов или включавшие специфическую популяцию (ХСНсФВ+ИБС или ХСНсФВ+АГ и т. д.) исключали из анализа. Извлекали исходные характеристики пациентов, а также данные о частоте приема бета-адреноблокаторов, распространенности АГ, ФП, ИБС, ИМ. Оценку трендов распространенности сопутствующих заболеваний и доли пациентов, принимающих бета-адреноблокаторы, в соответствии с годами включения участников в исследования проводили при помощи теста Манна–Кендалла.

Результаты   Из 718 отобранных публикаций полностью критериям включения и исключения соответствовали 14 РКИ. Частота приема бета-адреноблокаторов в период с 1993 по 2019 г. статистически значимо увеличилась (tau=0,51; p=0,014) и достигала 80 % в последних исследованиях. При этом распространенность ИБС, ИМ, АГ и ФП среди участников РКИ с ХСНсФВ статистически значимо не изменилась (все p>0,05). Однако если для АГ и ФП можно обсуждать тенденцию к увеличению распространенности (tau=0,4; p=0,055 и tau=0,043; p=0,063 соответственно), которая становилась статистически значимой для ФП при исключении из анализа исследования ALDO-DHF (tau=0,5; p=0,042), то распространенность ИМ имела тенденцию к уменьшению (tau= –0,73; p=0,06).

Заключение     Частота применения бета-адреноблокаторов в популяции пациентов на момент включения в РКИ по ХСНсФВ за последние 20 лет статистически значимо увеличилась, тогда как частота формальных поводов к их назначению (ФП, АГ, ИМ, ИБС) статистически значимо не изменилась.

 

Об авторах

Е. В. Кохан
Федеральное государственное автономное образовательное учреждение высшего образования «Российский университет дружбы народов» (РУДН), Москва
Россия

Клинический ординатор кафедры внутренних болезней с курсом кардиологии и функ­циональной диагностики имени академика В. С. Моисеева

SPIN-код: 1307-6750



Г. К. Киякбаев
Федеральное государственное автономное образовательное учреждение высшего образования «Российский университет дружбы народов» (РУДН), Москва
Россия

Доктор медицинских наук, профессор, профессор кафедры внутренних болезней с курсом кардиологии и функциональной диагностики имени академика В. С. Моисеева

SPIN-код: 3192-2303



Ж. Д. Кобалава
Федеральное государственное автономное образовательное учреждение высшего образования «Российский университет дружбы народов» (РУДН), Москва
Россия

Доктор медицинских на­ук, профессор, член-корреспондент РАН, заведующая кафедрой внутренних болезней с курсом кардиологии и функциональной диагностики имени академика В. С. Моисеева

SPIN-код: 9828-5409



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Для цитирования:


Кохан Е.В., Киякбаев Г.К., Кобалава Ж.Д. Частота и обоснованность назначения бета-адреноблокаторов у пациентов с хронической сердечной недостаточностью и сохраненной фракцией выброса: анализ динамики данных рандомизированных клинических исследований. Кардиология. 2020;60(6):30-40. https://doi.org/10.18087/cardio.2020.6.n1062

For citation:


Kokhan E.V., Kiyakbaev G.K., Kobalava Z.D. Frequency of use and Indications for Beta-Blockers in Heart Failure with Preserved Ejection Fraction. Kardiologiia. 2020;60(6):30-40. (In Russ.) https://doi.org/10.18087/cardio.2020.6.n1062

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