Datasheet1_Impact of amlodipine on clinical outcomes for heart failure in patients with dilated cardiomyopathy: a Korean nationwide cohort study.pdf

IntroductionAmlodipine, widely used as a first-line treatment for hypertension, has inconclusive clinical evidence regarding its efficacy in patients with heart failure. This retrospective cohort study aimed to investigate the clinical effectiveness of amlodipine treatment after hospitalization for heart failure in patients with dilated cardiomyopathy (DCMP).
MethodsA total of 20,851 patients who were diagnosed with DCMP and admitted for heart failure between 2005 and 2016 according to Korean nationwide medical insurance service database were enrolled. Amlodipine use was defined as its prescription at the time of discharge and for at least 180 days within a year. The primary outcome was all-cause death, and the secondary outcome was heart failure rehospitalization during a 5-year period. The outcomes between patients who received amlodipine (n = 6,798) and those who did not (n = 14,053) were compared.
ResultsDuring the 5-year follow-up, the group treated with amlodipine exhibited a significantly lower risk of all-cause death and heart failure rehospitalization than the group not treated with amlodipine [all-cause death: adjusted hazard ratio (HR): 0.64, 95% confidence interval (CI): 0.59–0.70, p < 0.001; cardiovascular death: adjusted HR: 0.71, 95% CI: 0.62–0.81, p < 0.001; heart failure rehospitalization: adjusted HR: 0.92, 95% CI: 0.86–0.98, p = 0.006]. In a subgroup analysis, amlodipine had a significant impact on decreasing all-cause mortality in older adults, those with a higher systolic blood pressure, and those with a lower Charlson Comorbidity Index.
ConclusionIn summary, amlodipine use after hospitalization for heart failure in patients with DCMP was associated with a lower risk of all-cause death and readmission for heart failure.

引言
氨氯地平（amlodipine）作为高血压的一线治疗药物被广泛应用，但其用于心力衰竭患者的临床疗效尚无定论。本回顾性队列研究旨在探讨扩张型心肌病（dilated cardiomyopathy, DCMP）患者因心力衰竭住院后接受氨氯地平治疗的临床有效性。

方法
本研究纳入2005年至2016年间，基于韩国全国医疗保险服务数据库确诊为扩张型心肌病且因心力衰竭住院的共计20851例患者。氨氯地平用药定义为出院时开具处方且在出院后一年内持续用药至少180天。本研究的主要终点为全因死亡（all-cause death），次要终点为5年内的心力衰竭再住院事件。比较接受氨氯地平治疗（n=6798）与未接受氨氯地平治疗（n=14053）患者的结局指标。

结果
在5年随访期间，接受氨氯地平治疗的患者全因死亡及心力衰竭再住院风险显著低于未接受治疗的患者[全因死亡：校正后风险比（adjusted hazard ratio, HR）=0.64，95%置信区间（confidence interval, CI）=0.59~0.70，p<0.001；心血管死亡：校正后HR=0.71，95%CI=0.62~0.81，p<0.001；心力衰竭再住院：校正后HR=0.92，95%CI=0.86~0.98，p=0.006]。亚组分析显示，氨氯地平可显著降低老年患者、收缩压较高患者及查尔森合并症指数（Charlson Comorbidity Index）较低患者的全因死亡率。

结论
综上，扩张型心肌病患者因心力衰竭住院后使用氨氯地平，与全因死亡及心力衰竭再住院风险降低显著相关。