Author(s):
Question:
Setting:
Bibliography:
Certainty assessment№ of patientsEffectCertaintyImportance
№ of studiesStudy designRisk of biasInconsistencyIndirectnessImprecisionOther considerationsbeetablokaatoritmitteRelative
(95% CI)		Absolute
(95% CI)
Üldine suremus, LVEF <40% (siinusrütm; jälgimisperioodi mediaan 1,3 aastat)
111,2,3,4,5,6,7,8,9,10,11,12,13,a,b
randomised trials
not serious
not serious
not serious
not serious
none
963/6861 (14.0%)
1192/6581 (18.1%)
RR 0.77
(0.72 to 0.84)
42 fewer per 1,000
(from 51 fewer to 29 fewer)
⨁⨁⨁⨁
High
Kardiovaskulaarne suremus, LVEF <20% (siinusrütm, jälgimisperioodi mediaan 1,3 aastat)
1112,c
randomised trials
not serious
not serious
not serious
not serious
none
236/1317 (17.9%)
300/1235 (24.3%)
RR 0.74
(0.63 to 0.86)
63 fewer per 1,000
(from 90 fewer to 34 fewer)
⨁⨁⨁⨁
High
Kardiovaskulaarne suremus, LVEF 20-25% (siinusrütm; jälgimisperioodi mediaan 1,3 aastat)
1112,c
randomised trials
not serious
not serious
not serious
not serious
none
242/1983 (12.2%)
292/1902 (15.4%)
RR 0.80
(0.68 to 0.94)
31 fewer per 1,000
(from 49 fewer to 9 fewer)
⨁⨁⨁⨁
High
Kardiovaskulaarne suremus, LVEF 26-34% (siinusrütm; jälgimisperioodi mediaan 1,3 aastat)
1112,c
randomised trials
not serious
not serious
not serious
not serious
none
226/2597 (8.7%)
290/2479 (11.7%)
RR 0.74
(0.63 to 0.88)
30 fewer per 1,000
(from 43 fewer to 14 fewer)
⨁⨁⨁⨁
High
Kardiovaskulaarne suremus, LVEF 35-39% (siinusrütm; jälgimisperioodi mediaan 1,3 aastat)
1112,c
randomised trials
not serious
not serious
not serious
seriousd
none
68/964 (7.1%)
89/965 (9.2%)
RR 0.73
(0.53 to 0.99)
25 fewer per 1,000
(from 43 fewer to 1 fewer)
⨁⨁⨁◯
Moderate
Hospitaliseerimine südamepuudulikkuse tõttu (siinusrütm; jälgimisperioodi mediaan 1,3 aastat)
1113,14,b,e
randomised trials
not serious
not serious
not serious
not serious
none
960/6960 (13.8%)
1272/6676 (19.1%)
RR 0.74
(0.68 to 0.79)
50 fewer per 1,000
(from 61 fewer to 40 fewer)
⨁⨁⨁⨁
High
Elukvaliteet (follow-up: mean 1 years; assessed with: Overall Treatment Evaluation Score; Living with Heart Failure )
115
randomised trials
seriousf
not serious
not serious
not serious
none
Hjalmarson et al, 2000 uuringust (n=3991) selgus, et 50% sekkumisrühma patsientidest ja 40% võrdlusrühma patsientidest sümptomid paranesid (OTE ehk Overall Treatment Evaluation Score skoori alusel); sekkumisrühmas oli suurem patsientide arv, kes hindasid raviefekti maksimaalselt kõrge OTE skooriga (6-7 punkti), tegemist oli statistiliselt olulise tulemusega (P=0.009) (Hjalmarson Å, 2000). Living with Heart failure skoor langes (paranes) sekkumisrühmas 0,7 punkti võrra (N=331) ning tõusis (halvenes) võrdlusrühmas (n=339), tegemist ei olnud siiski statistiliselt olulise tulemusega (MD -0,9, 95%CI -3,4 kuni 1.6, p=0.2).
⨁⨁⨁◯
Moderate

CI: confidence interval; RR: risk ratio

Explanations

a. Ziff et al, 2020 süstemaatilise ülevaate tulemused baseeruvad Cleland et al, 2018 süstemaatilise ülevaate ja metaanalüüsi tulemustele, mis haaras kokku 11 RCT andmeid; alagrupi analüüs tehti vastavalt uuringutesse kaasatud patsientide südame väljutusfraktsioonile ning kokku analüüsiti 13442 patsiendi andmeid, kelle EF jäi uuringusse kaasamisel alla 40% (keskmine EF 27%).
b. Ziff OJ, Samra M, Howard JP, Bromage DI, Ruschitzka F, Francis DP, Kotecha D. Beta-blocker efficacy across different cardiovascular indications: an umbrella review and meta-analytic assessment. BMC Med; 2020. 18(1):103
c. Cleland et al, 2018 on süstemaatiline ülevaade ja metaanalüüs, mis haaras kokku 11 RCT andmeid; alagrupi analüüs tehti vastavalt uuringutesse kaasatud patsientide südame väljutusfraktsioonile ning kokku analüüsiti 13442 patsiendi andmeid, kelle EF jäi uuringusse kaasamisel alla 40% (keskmine EF 27%).
d. 95% usaldusvahemik on lai.
e. Ziff et al, 2020 süstemaatilise ülevaate tulemused baseeruvad Kotecha et al, 2020 süstemaatilise ülevaate ja metaanalüüsi tulemustele, mis haarab 11 randomiseeritud kontrollitud uuringu andmeid; kokku analüüsiti 13636 siinusrütmiga patsienti, kelle keskmine LVEF jäi <45% (LVEF mediaanväärtus 27%).
f. Patsientide pimendamist ei ole kirjeldatud; uuring viidi läbi 313 erinevas meditsiinikeskuses, randomiseerimise ja uuringumetoodika ühtset protokolli ei ole esitatud; rühmadesse paigutamisel kasutati optimiseeritud randomiseerimise starteegiat, et tasakaalustada rühmad järgmiste kriteeriumite järgi: sugu, rass, SP põhjus, EF, MI ja diabeet anamneesis, NYHa klass.

References

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