title: Association between chronic heart failure and inhaled beta-2-adrenoceptor agonists.
abstract: BACKGROUND
  Recent reports suggest an association between beta-agonists and the risk of incident chronic heart failure (CHF). We sought to examine the association between inhaled beta-agonists and risk of incident and nonincident heart failure.
  
  
  METHODS
  We performed a nested case-control study within the Ambulatory Care Quality Improvement Project (ACQUIP). Case subjects were defined as having had a hospitalization with a primary discharge diagnosis of CHF. Controls were randomly selected from the ACQUIP cohort. The exposure was the number of beta-agonist canisters filled in the 90 days before an index date.
  
  
  RESULTS
  After adjusting for potentially confounding factors, there appeared to be no association between the use of inhaled beta-agonists and the risk of heart failure (1-2 canisters per month, OR 1.3 [95% CI 0.9, 1.8], > or =3 canisters per month, 1.1 [95% CI 0.8, 1.6]). However, among the cohort that had a history of CHF, there appeared to be a dose-response association between the number of inhaled beta-agonists and the risk of hospitalization for chronic heart failure (1-2 canisters per month, adjusted OR 1.8 [95% CI 1.1, 3.0], > or =3 canisters per month, adjusted OR 2.1 [95% CI 1.2, 3.8]).
  
  
  CONCLUSIONS
  beta-Agonists did not appear to be associated with incident heart failure but were associated with risk of CHF hospitalization among those subjects with a previous CHF diagnosis. Although a causal relationship cannot be inferred from these findings, further research is warranted to determine the safety and effectiveness of inhaled beta-agonists for patients with CHF.
authors.affiliation: Health Services Research and Development, Division of Pulmonary and Critical Care Medicine, VA Puget Sound Health Care System, Seattle, Wash 98108, USA. dau@u.washington.edu
authors.forename: David H
authors.initials: DH
authors.lastname: Au
authors.forename: Edmunds M
authors.initials: EM
authors.lastname: Udris
authors.forename: J Randall
authors.initials: JR
authors.lastname: Curtis
authors.forename: Mary B
authors.initials: MB
authors.lastname: McDonell
authors.forename: Stephan D
authors.initials: SD
authors.lastname: Fihn
mesh_terms: D000280:Administration, Inhalation; D000318:Adrenergic beta-Agonists / Q000009:adverse effects*; D000368:Aged; D016022:Case-Control Studies; D015986:Confounding Factors, Epidemiologic; D006333:Heart Failure / Q000139:chemically induced*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008875:Middle Aged; D012307:Risk Factors
chemical_list: D000318:Adrenergic beta-Agonists