COLA II研究PPT课件.ppt

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1、IsReluctancetoPrescribeCarvedilolintheElderlyJustified?TheCOLAIIStudyHenryKrumNHMRCCentreofClinicalResearchExcellenceinTherapeutics,MonashUniversityMelbourne,AustraliaKomajdaMetal.EurHeartJ2003Utilisationof-BlockadeforCHFinClinicalPractice33212117623736870%50%1

2、00%DiureticsACEInhibitorsβ-blockersDigoxinNitratesCalciumantagonistsSpironolactoneACEi,βB,diureticsBRINGUPReasonsforNotCommencingβ-BlockadeOnblockers(n=771)blockersstarted(n=865)Noblockers(n=1455)PvalueAge70years24%25%43%0.001NYHAIII-IV26%29%42%0.001Pulmonar

3、yrales10%20%26%0.001Periph.oedema12%13%21%0.001Atrialfibrillation14%17%21%0.001EFnotavailable5%3%6%0.008EF<30%30%30%35%0.017MaggioniAetal.Heart2003TrialΒblockerNMeanageBESTBucindolol270860CIBIS-IBisoprolol64160CIBIS-IIBisoprolol264761COPERNICUSCarvedilol228963MER

4、IT-HFMetoprololCR/XL399164USCarvedilolCarvedilol109458COMETCarvedilol/MetoprololCR302962Mean61AgeofPatientsinMajorβ-BlockerCHFClinicalTrials5.412.520.81.22.03.10%10%20%60-69yrs70-79yrs80+yrsNewlydiagnosedCHFPreviouslydiagnosedCHFKrumetal.MedJAust2001CASEStudyPat

5、ientswithHeartFailure(Totaln=22,060)Effectofβ-BlockervsPlaceboonMortalityNon-ElderlySubjectsStudy%WeightRiskratio(95%CI)0.57(0.41-0.80)13.20.35(0.14-0.88)2.30.66(0.53-0.82)27.90.61(0.47-0.80)20.60.91(0.78-1.07)COPERNICUSCIBISIIMERIT-HFBEST35.9Overall(95%CI)Riskra

6、tio.11100.72(0.65-0.80)CarvedilolU.S.TrialsEffectofβ-BlockervsPlaceboonMortalityElderlySubjects0.75(0.58-0.98)21.20.45(0.24-0.86)4.90.70(0.49-0.99)12.30.70(0.52-0.95)17.60.91(0.78-1.05)44.00.79(0.71-0.89)COPERNICUSCarvedilolU.S.TrialsCIBISIIMERIT-HFBESTOverall(95

7、%CI)Study%WeightRiskratio(95%CI).1110RiskratioSENIORSAllCauseMortalityorCVHospitalAdmissionNo.ofevents:Nebivolol332(31.1%);Placebo375(35.3%)EventfreeSurvival%HR0.86[0.74;0.99],p=0.0395060708090100061218243036Time(months)NebivololPlaceboHazardratioand95%CIDeathorC

8、VHospitalisationbySubgroupFavoursNebivololPlaceboNebivololFavoursPlacebo0.500.600.700.800.901.001.101.20125(33.6%)110(28.9%)>35%LVEF249(36.3%)219(32.1%)35%125