Study On Heart Rate Control And β-blockers In Patients With AMI During Hospitalization

BackgroundAcute myocardial infarction(AMI)is a common emergency and critical illness of the cardiovascular system,with a high rate of death and disability,which has caused a great social burden.Taking timely and effective treatment is an important measure to save patients’ lives and improve their quality of life.Many studies have shown that in the early stage of AMI,high sympathetic tone is often combined.Heart rate(HR),as an important performance indicator of sympathetic nerve activity,has been proven to be an independent predictor of the clinical prognosis of patients with AMI.Too high or too low heart rate will increase the incidence of adverse cardiovascular events in AMI patients.Therefore,the control of heart rate is particularly important in patients with acute myocardial infarction.Beta blockers are drugs that can control the heart rate by inhibiting sympathetic nerve activity.It can improve the prognosis of patients and is recommended by domestic and foreign guidelines for early use.However,there are few studies on the current status of heart rate control and the application of β-blockers during hospitalization of AMI patients.Therefore,further research will be conducted on the actual control of heart rate during hospitalization of AMI patients and the actual application of β-blockers.It is very necessary to clarify the difference from the guidelines recommended,and to explore the relationship between heart rate,β-blockers and hospital outcomes.Objectives1.To explore the heart rate control of patients with acute myocardial infarction during hospitalization and the application of β-blockers,and analyze whether they are different from the consensus guidelines recommendations.2.To explore the relationship between heart rate control,β-blocker application and adverse hospital outcomes in patients with acute myocardial infarction during hospitalization.MethodsCollected clinical data of 736 AMI patients in the Specialized ward of a tertiary hospital from January 1,2015 to December 31,2019,including gender,age,length of stay,heart rate at admission,heart rate three days before hospitalization,and time of discharge Heart rate,dosage of beta-blockers used in the first three days of hospitalization,dosage at discharge,discharge diagnosis,past medical history,examination results,surgical conditions,and hospital outcome,etc.A retrospective study was adopted.Count data is expressed by frequency and percentage,and differences between groups are tested by chi-square.The Kolmogorov-Smirnov test is used to distinguish whether the data is normally distributed.Measurement data conforming to the normal distribution are represented by mean±standard deviation.Differences between groups are analyzed by one-way analysis of variance.If the data does not conform to the normal distribution,the median and four are used.The quantile distance is expressed,and the difference between groups is tested by the rank sum test.In the analysis of risk factors for the in-hospital outcome of patients with acute myocardial infarction,multivariate logistic regression analysis was used to calculate the odds ratio and 95%confidence interval.For repeated measurement data,we use the "repeated measurement multi-factor mixed model" to analyze and describe its trend changes.Creatinine(Cr),Creatinine kinase-MB Isoenzyme(CK-MB),Total cholesterol(TC),Triglycerides(TG),Low-density lipoprotein cholesterol(LDL-C),N-terminal pro-brain natriuretic peptide(NT-proBNP)and left ventricular ejection fraction(LVEF)were filled with median.All data were processed and analyzed using IBM SPSS Statistics 26 software,using a two-way test,and P<0.05 was statistically significant.Results1.Among the 736 patients with AMI,94 patients had MACE in the hospital,accounting for 12.8%,including 8 deaths,1 stroke,40 cardiogenic shock,2 emergency revascularization,and 76 acute heart failure.People accounted for 1.1%,0.1%,5.4%,0.3%and 10.3%respectively.2.Heart rate control of AMI patients during hospitalization:The average heart rate of AMI patients upon admission was 79±13bpm,and the average heart rates on the first day of hospitalization,second day of hospitalization,third day of hospitalization and discharge were 74±13bpm and 74±13bpm,respectively,73±11bpm,74±9bpm,the heart rate compliance rate is 10.1%,7.9%,9.4%,4.4%,respectively.AMI patients with a heart rate of 60-69 bpm accounted for 25.8%,29.9%,29.5%,31%,25.7%,and AMI patients with a heart rate of 70-79 bpm accounted for 28.9%,30.0%,30.7%,35.7%,50.0,respectively.%,AMI patients with a heart rate of 80-89bpm accounted for 25.1%,19.0%,19.6%,17.9%,16.8%,and AMI patients with a heart rate of 90-99bpm accounted for 13.0%,8.6%,7.7%,4.8%,respectively,2.3%,AMI patients with a heart rate of≥100bpm accounted for 7.1%,3.7%,3.3%,2.0%,1.4%respectively.Among them,patients with a heart rate of 70-79bpm accounted for the most and their proportion gradually increased,with a heart rate of 90-The proportion of patients with 99bpm and≥100bpm gradually decreased.During the hospitalization period,the heart rate showed a downward trend.Among them,the heart rate decreased most significantly from the time of admission to the first day of hospitalization,and the heart rate changes tended to be flat on the second and third days of hospitalization.3.Application of β-blockers in AMI patients during hospitalization:The application rate of β-blockers in AMI patients on the first day of hospitalization was 47.6%,among which,in terms of type selection,metoprolol sustained-release tablets were mainly used Mainly,accounting for 94.9%,The application rates on the second day of hospitalization,the third day of hospitalization,and discharge were 53.7%,64.0%,and 83.2%,respectively.The application rate has increased significantly.In terms of applied dose,patients with≤1/8 target dose(excluding non-application)accounted for 43.8%,46.6%,52.9%,47.8%,respectively,patients with>1/8 target dose and≤1/4 target dose respectively 2.9%,6.5%,10.3%,29.1%,patients>1/4 target dose and≤1/2 target dose accounted for 0.1%,0.5%,0.8%,6.1%,>1/2 target dose Of patients only appeared at discharge,accounting for 0.1%.The average daily dose of metoprolol was 21.1 ±9.3mg、23.2±11.5mg、23.9±12.7mg 和 33.2±18.7mg,respectively.The average daily dose gradually increased.4.Compared with patients in the Metoprolol group,the patients in the Metoprolol group had higher heart rates on admission,the first day,the second day,and the third day of hospitalization,but the heart rate was lower at discharge.The heart rate of patients in the metoprolol group showed a downward trend,while the heart rate of patients in the non-applied group showed a "U"-shaped change trend.The heart rates of the two groups were statistically different(P<0.05).5.Compared with patients without MACE,patients in MACE group had poorer heart rate control during hospitalization(P<0.05).6.The Metoprolol during hospitalization can reduce the incidence of major adverse cardiovascular events,deaths and cardiogenic shock(P<0.05).7.The heart rate on the second day of hospitalization is an independent risk factor for MACE and acute heart failure in AMI patients.The heart rate on the second day of hospitalization increased one unit,the risk of MACE and acute heart failure in the hospital of AMI patients increased by 3.4%and 4.1%,respectively.Heart rate on the third day of hospitalization is an independent risk factor for cardiogenic shock and death in AMI patients.One unit higher of heart rate on the third day of hospitalization,the risk of cardiogenic shock and death in the hospital of AMI patients increased by 6.5%and 18.5%,respectively.Conclusions1.Patients with acute myocardial infarction have poor heart rate control during hospitalization,which is somewhat different from the consensus guidelines.As the main drugs for heart rate control,beta-blockers has problems with low application rates and small doses.2.Heart rate in the early hospitalization is an independent predictor of the short-term clinical prognosis of patients with acute myocardial infarction.Metoprolol during hospitalization can reduce the incidence of adverse cardiovascular events in patients with acute myocardial infarction.