title: Randomized trial to determine the effect of nebivolol on mortality and cardiovascular hospital admission in elderly patients with heart failure (SENIORS).
abstract: OBJECTIVE
  Large randomized trials have shown that beta-blockers reduce mortality and hospital admissions in patients with heart failure. The effects of beta-blockers in elderly patients with a broad range of left ventricular ejection fraction are uncertain. The SENIORS study was performed to assess effects of the beta-blocker, nebivolol, in patients >/=70 years, regardless of ejection fraction.
  
  
  RESULTS
  We randomly assigned 2128 patients aged >/=70 years with a history of heart failure (hospital admission for heart failure within the previous year or known ejection fraction </=35%), 1067 to nebivolol (titrated from 1.25 mg once daily to 10 mg once daily), and 1061 to placebo. The primary outcome was a composite of all cause mortality or cardiovascular hospital admission (time to first event). Analysis was by intention to treat. Mean duration of follow-up was 21 months. Mean age was 76 years (SD 4.7), 37% were female, mean ejection fraction was 36% (with 35% having ejection fraction >35%), and 68% had a prior history of coronary heart disease. The mean maintenance dose of nebivolol was 7.7 mg and of placebo 8.5 mg. The primary outcome occurred in 332 patients (31.1%) on nebivolol compared with 375 (35.3%) on placebo [hazard ratio (HR) 0.86, 95% CI 0.74-0.99; P=0.039]. There was no significant influence of age, gender, or ejection fraction on the effect of nebivolol on the primary outcome. Death (all causes) occurred in 169 (15.8%) on nebivolol and 192 (18.1%) on placebo (HR 0.88, 95% CI 0.71-1.08; P=0.21).
  
  
  CONCLUSIONS
  Nebivolol, a beta-blocker with vasodilating properties, is an effective and well-tolerated treatment for heart failure in the elderly.
authors.affiliation: Clinical Trials and Evaluation Unit, Royal Brompton and Harefield NHS Trust, London, UK.
authors.forename: Marcus D
authors.initials: MD
authors.lastname: Flather
authors.forename: Marcelo C
authors.initials: MC
authors.lastname: Shibata
authors.forename: Andrew J S
authors.initials: AJ
authors.lastname: Coats
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: Van Veldhuisen
authors.forename: Aleksandr
authors.initials: A
authors.lastname: Parkhomenko
authors.forename: Joszef
authors.initials: J
authors.lastname: Borbola
authors.forename: Alain
authors.initials: A
authors.lastname: Cohen-Solal
authors.forename: Dan
authors.initials: D
authors.lastname: Dumitrascu
authors.forename: Roberto
authors.initials: R
authors.lastname: Ferrari
authors.forename: Philippe
authors.initials: P
authors.lastname: Lechat
authors.forename: Jordi
authors.initials: J
authors.lastname: Soler-Soler
authors.forename: Luigi
authors.initials: L
authors.lastname: Tavazzi
authors.forename: Lenka
authors.initials: L
authors.lastname: Spinarova
authors.forename: Jiri
authors.initials: J
authors.lastname: Toman
authors.forename: Michael
authors.initials: M
authors.lastname: Böhm
authors.forename: Stefan D
authors.initials: SD
authors.lastname: Anker
authors.forename: Simon G
authors.initials: SG
authors.lastname: Thompson
authors.forename: Philip A
authors.initials: PA
authors.lastname: Poole-Wilson
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D000369:Aged, 80 and over; D001578:Benzopyrans / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D002423:Cause of Death; D004311:Double-Blind Method; D004983:Ethanolamines / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000188:drug therapy*; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008297:Male; D000068577:Nebivolol; D010349:Patient Compliance; D013318:Stroke Volume / Q000187:drug effects; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000627:therapeutic use*
chemical_list: D000319:Adrenergic beta-Antagonists; D001578:Benzopyrans; D004983:Ethanolamines; D014665:Vasodilator Agents; D000068577:Nebivolol