당뇨를 동반한 심부전 환자에 대한 beta-blocker의 유효성 평가

Abstract

Purpose: A retrospective study was performed to assess the efficacy and tolerance of β-blocker administration in patients with heart failure and diabetes. Method: Records of 164 patients who were treated for the heart failure condition more than a year were studied retrospectively. Patients were divided into 4 groups based on their diabetes(DM) status and the administration of β-blockers (DM+β-blocker group: 14, DM w/o β-blocker: 19, No DM + β-blocker: 62, No DM + no β-blocker: 69). All patients had been receiving conventional therapy such as digoxin, ACE-I, ARB, diuretics, nitrates, aspirin, anticoagulants or lipid-lowering agents. The primary endpoints (death and hospital admission) were recorded during 1 year period and hemodynamic factors (HR, LVEF, SBP, DBP) were obtained from all patient groups before and after 12 months of β-blocker treatment. To evaluate toxicity of β-blocker, SCr, BUN, AST, ALT and Alkaline phosphatase were obtained. Result: There were less death and hospital admission in DM + β-blocker group than in DM without β-blocker group (p=0.014). Relative risk of hospital admission for DM+β-blocker group over no DM group was 1.17. Long term β-blocker administration was associated with an improvement of heart rate in patients with DM (P< 0.02) with no significant improvement of LVEF, SBP, DBP. in DM patient. In patient without DM, β-blocker was associated with improvement in LVEF, HR and DBP (P<0.01, P<0.03), but not in SBP. The incidence of toxicity was similar between the four group with no significant difference. Conculsion: Treatment of heart failure patients with β-blocker appears to be beneficial in terms of hospital admission event and several hemodynamic factors. The toxicities of β-blocker treatment were not significant and the treatment is generally well-tolerated in most of the heart failure patients.