Effectiveness of beta-blocker therapy in daily practice patients with advanced chronic heart failure; is there an effect-modification by age?

D. Dobre, M.J.L. deJongste, C. Lucas, G. Cleuren, D.J. van Veldhuisen, A.V. Ranchor, F. Haaijer-Ruskamp

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Abstract

Aims The effects of beta-blockers in daily practice patients with advanced chronic heart failure (CHF) and a broad range of ejection fraction (EF) are not well established. We aimed to assess, first, the association between beta-blocker prescription at discharge and mortality in a cohort of patients with advanced CHF, and second, whether this association is modified by the age of the patient.

Methods Patients diagnosed with advanced CHF (n = 625) were prospectively followed after discharge from the Cardiology Department. The mean age was 76 years, 53% male, mean EF 42 +/- 16%. Overall, 308 (49%) patients had a beta-blocker prescribed at discharge, 140 (22%) low-dose and 168 (27%) high-dose therapy. We used multivariate Cox analysis to assess the association between beta-blocker use at discharge and mortality.

Results After a mean follow-up of 22 months, 117 (27%) patients died. Prescription of a beta-blocker was associated with a 45% relative risk reduction (hazard ratio 0.55, 95% confidence interval 0.39, 0.78). The relative risk reduction was similar with low and high doses of beta-blockers (42% and 49%). However, the relative risk reduction was higher in younger than in older patients (P = 0.006). In patients 75 years old it was associated with 21% risk reduction.

Conclusions In this daily practice cohort of patients with advanced CHF, prescription of a beta-blocker was associated with significant mortality reduction. However, the beneficial effects of beta-blockers appear to be greater in younger patients.

Original languageEnglish
Pages (from-to)356-364
Number of pages9
JournalBritish Journal of Clinical Pharmacology
Volume63
Issue number3
DOIs
Publication statusPublished - Mar-2007

Keywords

  • beta-blockers
  • advanced chronic heart failure
  • daily practice
  • mortality
  • VENTRICULAR EJECTION FRACTION
  • ELDERLY-PATIENTS
  • HOSPITAL DISCHARGE
  • CLINICAL-TRIALS
  • MERIT-HF
  • MORTALITY
  • DYSFUNCTION
  • CARVEDILOL
  • EXPERIENCE
  • MORBIDITY

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