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

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.

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