Survival and hospitalization in heart failure patients with or without diabetes treated with beta-blockers.
BACKGROUND
Physicians are still concerned about prescribing beta-blockers in diabetic patients with heart failure.


METHODS
In the outcome research study (the Beta-Blockers in Patients With Congestive Heart Failure: Guided Use in Clinical Practice [BRING-UP] study), the responsible clinicians could decide whether to start beta-blocker treatment and which agent to use. A total of 3091 patients were enrolled by 202 cardiologic centers: 25% of the recruited patients were already on beta-blockers, 28% started treatment at the enrollment visit, and 47% were not started on beta-blockers.


RESULTS
The 1-year mortality, hospitalization rate, and the combined end point of mortality or hospitalization were higher in diabetic patients (15.8% versus 10.9%; relative risk [RR] = 1.44; 95% confidence intervals [CI] 1.16-1.78, P =.001) (31.0% versus 24.0%; RR = 1.28; 95% CI 1.11-1.49; P =.0009) (40.5% versus 30.1%; RR = 1.35; 95% CI 1.19-1.51; P =.0001). The event-free analysis of the 4 groups (diabetic patients not treated with beta-blockers, diabetic patients treated with beta-blockers, nondiabetic patients not treated with beta-blockers, nondiabetic patients treated with beta-blockers) showed that patients treated with beta-blockers had a higher event-free probability than patients not treated with beta-blockers regardless the presence of diabetes (P <.0001).


CONCLUSIONS
On the basis of post hoc analysis, diabetic patients with chronic heart failure benefit from beta-blockers even if at a lower degree. Thus, there are no justifications to avoid beta-blockers in heart failure patients in the presence of diabetes.
Bobbio
Marco
M
University Division of Cardiology, Turin, Italy.
Ferrua
Stefania
S
Opasich
Cristina
C
Porcu
Maurizio
M
Lucci
Donata
D
Scherillo
Marino
M
Tavazzi
Luigi
L
Maggioni
Aldo Pietro
AP
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D003920:Diabetes Mellitus / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D012189:Retrospective Studies; D015996:Survival Rate
D000319:Adrenergic beta-Antagonists