Comparison of Late Mortality in Hospitalized Patients >70 Years of Age With Systolic Heart Failure Receiving Beta Blockers Versus Those Not Receiving Beta Blockers

• Published in: The American journal of cardiology Vol. 102; no. 12; pp. 1711 - 1717
• Main Authors: Pascual-Figal, Domingo A., MD, PhD, Redondo, Belen, MD, Caro, Cesar, MD, Manzano, Sergio, MD, Garrido, Iris P., MD, Ruipérez, Juan A., MD, PhD, Valdés, Mariano, MD, PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 15.12.2008; Elsevier; Elsevier Limited
• Subjects: Acute Disease; Adrenergic beta-Antagonists - administration & dosage; Adrenergic beta-Antagonists - therapeutic use; Aged; Aged, 80 and over; Beta blockers; Biological and medical sciences; Cardiology; Cardiology. Vascular system; Cardiovascular; Dose-Response Relationship, Drug; Drug therapy; Female; Heart; Heart failure; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; Heart Failure, Systolic - drug therapy; Heart Failure, Systolic - mortality; Hospitalization; Humans; Kaplan-Meier Estimate; Male; Medical sciences; Mortality; Multivariate Analysis; Proportional Hazards Models; Regression analysis; Risk Factors; Selection Bias; Studies; Survival Rate; Ventricular Dysfunction, Left; Human; Heart failure; Late; Prognosis; Mortality; Cardiovascular disease; Epidemiology; Heart disease; Circulatory system; Cardiology; Age; Comparative study; Beta blocking agent
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2008.07.059

Beta blockers are underprescribed to elderly patients with systolic heart failure (HF). We studied whether the prescription of a β blocker is associated with a survival benefit in a nonselected population of patients >70 years of age hospitalized with acute HF and systolic dysfunction. We studied 272 consecutive patients >70 years (median 77.0, interquartile range 73.4 to 81.1) hospitalized with acute HF (left ventricular ejection fraction 34 ± 8%) during a 2-year period. At discharge, β-blocker therapy was prescribed in 139 patients (51.1%). A propensity score for the likelihood of receiving β-blocker therapy was developed and showed a good performance (c-statistic = 0.825 and Hosmer-Lemeshow p = 0.820). After discharge, 120 patients (44.1%) died during the follow-up (median 31 months, interquartile range 12 to 46). Cox regression analysis showed a lower risk of death associated with β-blocker prescription (p <0.001, hazard ratio [HR] 0.450, 95% confidence interval [CI] 0.310 to 0.655), which persisted after risk adjusting for the propensity score (HR 0.521, 95% CI 0.325 to 0.836, p = 0.007). In a propensity-matched cohort of 130 patients, there was a significantly lower mortality in patients receiving β blockers (log rank 0.009, HR 0.415, 95% CI 0.234 to 0.734, p = 0.003). Risk reduction associated with β blockade was observed with both high doses (HR 0.472, 95% CI 0.300 to 0.742, p = 0.001) and low doses (HR 0.425, 95% CI 0.254 to 0.711, p = 0.001). In conclusion, β-blocker prescription at discharge in a nonselected population >70 years of age hospitalized with systolic HF is associated with a significantly lower risk of death even at low doses. This benefit remains consistent after adjustment for potential confounders.