Beta-blockers in older patients with heart failure and preserved ejection fraction: Class, dosage, and outcomes

Kanan Patel, Gregg C. Fonarow, O. James Ekundayo, Inmaculada B. Aban, Meredith L. Kilgore, Thomas E. Love, Dalane W. Kitzman, Mihai Gheorghiade, Richard M. Allman, Ali Ahmed*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

33 Scopus citations

Abstract

Background We examined the clinical effectiveness of beta-blockers considered evidenced-based to heart failure and reduced ejection fraction (HFrEF) and their recommended target doses in older adults with HF and preserved ejection fraction (HFpEF). Methods In OPTIMIZE-HF (2003-2004) linked to Medicare (2003-2008), of the 10,570 older (age ≥ 65 years, mean, 81 years) adults with HFpEF (EF ≥ 40%, mean 55%), 8373 had no contraindications to beta-blocker therapy. After excluding 4614 patients receiving pre-admission beta-blockers, the remaining 3759 patients were potentially eligible for new discharge prescriptions for beta-blockers and 1454 received them. We assembled a propensity-matched cohort of 1099 pairs of patients receiving beta-blockers and no beta-blockers, balanced on 115 baseline characteristics. Evidence-based beta-blockers for HFrEF, namely, carvedilol, metoprolol succinate, and bisoprolol and their respective guideline-recommended target doses were 50, 200, and 10 mg/day. Results During 6 years of follow-up, new discharge prescriptions for beta-blockers had no association with the primary composite endpoint of all-cause mortality or HF rehospitalization (hazard ratio, 1.03; 95% confidence interval {CI}, 0.94-1.13; p = 0.569). This association did not vary by beta-blocker evidence class or daily dose. Hazard ratios for all-cause mortality and HF rehospitalization were 0.99 (95% CI, 0.90-1.10; p = 0.897) and 1.17 (95% CI, 1.03-1.34; p = 0.014), respectively. The latter association lost significance when higher EF cutoffs of ≥ 45%, ≥ 50% and ≥ 55% were used. Conclusions Initiation of therapy with beta-blockers considered evidence-based for HFrEF and in target doses recommended for HFrEF had no association with the composite or individual endpoints of all-cause mortality or HF rehospitalization in HFpEF.

Original languageEnglish (US)
Pages (from-to)393-401
Number of pages9
JournalInternational Journal of Cardiology
Volume173
Issue number3
DOIs
StatePublished - May 15 2014

Keywords

  • Beta-blockers
  • Heart failure
  • Preserved ejection fraction

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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