Age is not a significant risk factor for failed trial of beta-blocker therapy in older patients with chronic heart failure.
OBJECTIVE
To evaluate how well older heart failure patients tolerate beta-blockers in everyday clinical practice.


METHODS
Retrospective casenote analysis.


METHODS
Specialist heart failure clinic in a large teaching hospital.


METHODS
226 patients with a clinical diagnosis of heart failure and evidence of left ventricular systolic dysfunction.


METHODS
Data on age, sex, comorbid illness, other medications, duration of beta-blocker therapy, side-effects and reasons for discontinuation.


RESULTS
Patients aged 75 years and over had a higher level of comorbid disease and worse New York Heart Association status. Despite this, 60.4% of those aged 75 or over had been tried on a beta-blocker (versus 69% of those aged <75), and of those tried, 80% of those aged 75 or over were still taking a beta-blocker at the time of survey (versus 86% of those aged <75). Forty-seven percent of those aged 75 or over had at least one side-effect recorded (versus 48% of those aged <75). Significant risk factors for failing a trial of beta-blocker therapy were worse New York Heart Association status and worse left ventricular function, but importantly not age.


CONCLUSIONS
A high proportion of older heart failure patients tolerate beta-blockers. Side-effects and failure rates are comparable to younger patients. Left ventricular function and worse New York Heart Association class, rather than age, predict low tolerability of therapy. Further studies are warranted to evaluate whether frail patients with heart failure can improve their quality of life by taking beta-blockers.
Witham
Miles D
MD
Section of Ageing and Health, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK. m.witham@dundee.ac.uk
Gillespie
Neil D
ND
Struthers
Allan D
AD
D000319:Adrenergic beta-Antagonists / Q000009:adverse effects* / Q000627:therapeutic use; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D015897:Comorbidity; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010352:Patient Dropouts / Q000706:statistics & numerical data; D011788:Quality of Life; D012189:Retrospective Studies; D012307:Risk Factors; D017211:Treatment Failure; D018487:Ventricular Dysfunction, Left / Q000188:drug therapy / Q000453:epidemiology
D000319:Adrenergic beta-Antagonists