Phillip H Lam1, Neha Gupta2, Daniel J Dooley2, Steven Singh3, Prakash Deedwania4, Michael R Zile5, Deepak L Bhatt6, Charity J Morgan7, Bertram Pitt8, Gregg C Fonarow9, Ali Ahmed10. 1. Veterans Affairs Medical Center, Washington, DC; Brigham and Women's Hospital Heart & Vascular Center, Boston, Mass. 2. Veterans Affairs Medical Center, Washington, DC; Georgetown University, Washington, DC; MedStar Heart and Vascular Institute, Washington, DC. 3. Veterans Affairs Medical Center, Washington, DC; Georgetown University, Washington, DC. 4. Veterans Affairs Medical Center, Washington, DC; University of California, San Francisco, Fresno. 5. Ralph H. Johnson VA Medical Center and Medical University of South Carolina, Charleston. 6. Brigham and Women's Hospital Heart & Vascular Center, Boston, Mass; Harvard Medical School, Boston, Mass. 7. University of Alabama at Birmingham, Ann Arbor. 8. University of Michigan, Ann Arbor. 9. University of California, Los Angeles. 10. Veterans Affairs Medical Center, Washington, DC; George Washington University, Washington, DC. Electronic address: ali.ahmed@va.gov.
Abstract
BACKGROUND: Beta-blockers in high target doses are recommended for heart failure with reduced ejection fraction (HFrEF) but not for preserved ejection fraction (HFpEF). Treatment benefits are often more pronounced in high-risk subgroups, and patients with HFpEF with heart rate ≥70 beats per minute have emerged as such a high-risk subgroup. We examined the associations of high-dose beta-blocker use with outcomes in these patients. METHODS: Of the 8462 hospitalized patients with heart failure with ejection fraction ≥50% in the Medicare-linked Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF) registry, 5422 had a discharge heart rate ≥70 beats per minute. Of these, 4537 had no contraindications to beta-blocker use, of which 2797 (2592 with dose data) received prescriptions for beta-blockers. Of the 2592, 730 received high-dose beta-blockers, defined as atenolol ≥100 mg/day, carvedilol ≥50 mg/day, metoprolol tartrate or succinate ≥200 mg/day, or bisoprolol ≥10 mg/day, and 1740 received no beta-blockers. Using propensity scores for the receipt of high-dose beta-blockers, we assembled a matched cohort of 1280 patients, balanced on 58 characteristics. RESULTS: All-cause mortality occurred in 63% and 68% of matched patients receiving high-dose beta-blocker vs no beta-blocker, respectively, during 6 years (median, 2.8) of follow-up (hazard ratio, 0.86; 95% confidence interval, 0.75-0.98; P = .027). The hazard ratios (95% confidence intervals) for all-cause readmission and the combined endpoint of all-cause readmission or all-cause mortality associated with high-dose beta-blocker use were 0.90 (0.81-1.02) and 0.89 (0.80-1.00), respectively. CONCLUSIONS: In patients with HFpEF and heart rate ≥70 beats per minute, high-dose beta-blocker use was associated with a significantly lower risk of death. Future randomized controlled trials are needed to examine this association. Published by Elsevier Inc.
BACKGROUND: Beta-blockers in high target doses are recommended for heart failure with reduced ejection fraction (HFrEF) but not for preserved ejection fraction (HFpEF). Treatment benefits are often more pronounced in high-risk subgroups, and patients with HFpEF with heart rate ≥70 beats per minute have emerged as such a high-risk subgroup. We examined the associations of high-dose beta-blocker use with outcomes in these patients. METHODS: Of the 8462 hospitalized patients with heart failure with ejection fraction ≥50% in the Medicare-linked Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF) registry, 5422 had a discharge heart rate ≥70 beats per minute. Of these, 4537 had no contraindications to beta-blocker use, of which 2797 (2592 with dose data) received prescriptions for beta-blockers. Of the 2592, 730 received high-dose beta-blockers, defined as atenolol ≥100 mg/day, carvedilol ≥50 mg/day, metoprolol tartrate or succinate ≥200 mg/day, or bisoprolol ≥10 mg/day, and 1740 received no beta-blockers. Using propensity scores for the receipt of high-dose beta-blockers, we assembled a matched cohort of 1280 patients, balanced on 58 characteristics. RESULTS: All-cause mortality occurred in 63% and 68% of matched patients receiving high-dose beta-blocker vs no beta-blocker, respectively, during 6 years (median, 2.8) of follow-up (hazard ratio, 0.86; 95% confidence interval, 0.75-0.98; P = .027). The hazard ratios (95% confidence intervals) for all-cause readmission and the combined endpoint of all-cause readmission or all-cause mortality associated with high-dose beta-blocker use were 0.90 (0.81-1.02) and 0.89 (0.80-1.00), respectively. CONCLUSIONS: In patients with HFpEF and heart rate ≥70 beats per minute, high-dose beta-blocker use was associated with a significantly lower risk of death. Future randomized controlled trials are needed to examine this association. Published by Elsevier Inc.
Authors: Ismail Erturk; Kenan Saglam; Sadi Elasan; Musa B Aykan; Ramazan Acar; Fatih Yesildal; Fevzi N Aydin; Taner Ozgurtas Journal: Saudi Med J Date: 2018-10 Impact factor: 1.484
Authors: Charles Faselis; Phillip H Lam; Michael R Zile; Poonam Bhyan; Apostolos Tsimploulis; Cherinne Arundel; Samir Patel; Peter Kokkinos; Prakash Deedwania; Deepak L Bhatt; Qing Zeng-Trietler; Charity J Morgan; Wilbert S Aronow; Richard M Allman; Gregg C Fonarow; Ali Ahmed Journal: Am J Med Date: 2020-09-30 Impact factor: 4.965