Davide Stolfo1,2, Alicia Uijl1,3,4, Lina Benson1, Benedikt Schrage1,5, Marat Fudim6, Folkert W Asselbergs4,7,8, Stefan Koudstaal4,7, Gianfranco Sinagra2, Ulf Dahlström9, Giuseppe Rosano10,11, Gianluigi Savarese1. 1. Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden. 2. Division of Cardiology, Cardiovascular Department, Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), Trieste, Italy. 3. Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands. 4. Health Data Research UK London, Institute for Health Informatics, University College London, London, UK. 5. Department of General and Interventional Cardiology and German Center for Cardiovascular Research (DZHK), partner site Hamburg/Lübeck/Kiel, University Heart Centre Hamburg, Hamburg, Germany. 6. Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC, USA. 7. Department of Cardiology, Division Heart & Lungs, University Medical Center, Utrecht University, Utrecht, The Netherlands. 8. Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, UK. 9. Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden. 10. Centre for Clinical and Basic Research, Department of Medical Sciences, IRCCS San Raffaele Pisana, Rome, Italy. 11. Cardiovascular and Cell Sciences Institute, St George's, University of London, London, UK.
Abstract
BACKGROUND: Beta-blockers reduce mortality and morbidity in heart failure (HF) with reduced ejection fraction (HFrEF). However, patients older than 80 years are poorly represented in randomized controlled trials. We assessed the association between beta-blocker use and outcomes in HFrEF patients aged ≥80 years. METHODS AND RESULTS: We included patients with an ejection fraction <40% and aged ≥80 years from the Swedish HF Registry. The association between beta-blocker use, all-cause mortality and cardiovascular (CV) mortality/HF hospitalization was assessed by Cox proportional hazard models in a 1:1 propensity score-matched cohort. To assess consistency, the same analyses were performed in a positive control cohort with age <80 years. A negative control outcome analysis was run using hospitalization for cancer as endpoint. Of 6562 patients aged ≥80 years, 5640 (86%) received beta-blockers. In the matched cohort including 1732 patients, beta-blocker use was associated with a significant reduction in the risk of all-cause mortality [hazard ratio (HR) 0.89, 95% confidence interval (CI) 0.79-0.99]. Reduction in CV mortality/HF hospitalization was not significant (HR 0.94, 95% CI 0.85-1.05) due to the lack of association with HF hospitalization, whereas CV death was significantly reduced. After adjustment rather than matching for the propensity score in the overall cohort, beta-blocker use was associated with reduced risk of all outcomes. In patients aged <80 years, use of beta-blockers was associated with reduced risk of all-cause death (HR 0.79, 95% CI 0.68-0.92) and of the composite outcome (HR 0.88, 95% CI 0.77-0.99). CONCLUSIONS: In HFrEF patients ≥80 years of age, use of beta-blockers was high and was associated with improved all-cause and CV survival.
BACKGROUND: Beta-blockers reduce mortality and morbidity in heart failure (HF) with reduced ejection fraction (HFrEF). However, patients older than 80 years are poorly represented in randomized controlled trials. We assessed the association between beta-blocker use and outcomes in HFrEF patients aged ≥80 years. METHODS AND RESULTS: We included patients with an ejection fraction <40% and aged ≥80 years from the Swedish HF Registry. The association between beta-blocker use, all-cause mortality and cardiovascular (CV) mortality/HF hospitalization was assessed by Cox proportional hazard models in a 1:1 propensity score-matched cohort. To assess consistency, the same analyses were performed in a positive control cohort with age <80 years. A negative control outcome analysis was run using hospitalization for cancer as endpoint. Of 6562 patients aged ≥80 years, 5640 (86%) received beta-blockers. In the matched cohort including 1732 patients, beta-blocker use was associated with a significant reduction in the risk of all-cause mortality [hazard ratio (HR) 0.89, 95% confidence interval (CI) 0.79-0.99]. Reduction in CV mortality/HF hospitalization was not significant (HR 0.94, 95% CI 0.85-1.05) due to the lack of association with HF hospitalization, whereas CV death was significantly reduced. After adjustment rather than matching for the propensity score in the overall cohort, beta-blocker use was associated with reduced risk of all outcomes. In patients aged <80 years, use of beta-blockers was associated with reduced risk of all-cause death (HR 0.79, 95% CI 0.68-0.92) and of the composite outcome (HR 0.88, 95% CI 0.77-0.99). CONCLUSIONS: In HFrEF patients ≥80 years of age, use of beta-blockers was high and was associated with improved all-cause and CV survival.
Authors: Willemien J Kruik-Kollöffel; Job van der Palen; Carine J M Doggen; Marissa C van Maaren; H Joost Kruik; Edith M Heintjes; Kris L L Movig; Gerard C M Linssen Journal: PLoS One Date: 2020-12-22 Impact factor: 3.240
Authors: Lorenzo Stretti; Dauphine Zippo; Andrew J S Coats; Markus S Anker; Stephan von Haehling; Marco Metra; Daniela Tomasoni Journal: ESC Heart Fail Date: 2021-12-16
Authors: Alicia Uijl; Gianluigi Savarese; Ilonca Vaartjes; Ulf Dahlström; Jasper J Brugts; Gerard C M Linssen; Vanessa van Empel; Hans-Peter Brunner-La Rocca; Folkert W Asselbergs; Lars H Lund; Arno W Hoes; Stefan Koudstaal Journal: Eur J Heart Fail Date: 2021-05-01 Impact factor: 15.534