title: Association of beta-blocker use with mortality among patients with congestive heart failure in the Cardiovascular Health Study (CHS).
abstract: BACKGROUND
  In clinical trials, beta-blocker therapy reduces all-cause mortality among people with congestive heart failure (CHF) characterized by depressed systolic function, but few trials included large numbers of elderly participants. This study assessed the association between beta-blocker therapy and mortality among community-dwelling older adults with CHF.
  
  
  METHODS
  The Cardiovascular Health Study (CHS) is a longitudinal, population-based study of adults aged > or = 65 years. Recruitment began in 1989 with follow-up extending through June 2000 or death. Cox proportional hazard regression models were used to assess the association between beta-blocker therapy and all-cause mortality among 950 participants who developed new-onset CHF.
  
  
  RESULTS
  beta-Blocker users (n = 157) were more likely than nonusers (n = 793) to have treated hypertension, clinical coronary artery disease, and valvular disease at the time of CHF diagnosis. Death occurred in 67 users and 446 nonusers during a median follow-up of 2.3 years. Compared with nonuse, use of beta-blockers was associated with a multivariable adjusted hazard ratio (HR) of 0.74 (95% CI 0.56-0.98) for all-cause mortality. Among the 520 participants who had left ventricular ejection fraction assessed within 90 days after CHF diagnosis, the risk for all cause mortality associated with beta-blocker use did not differ significantly between those with ejection fraction of < 40% and those with ejection fraction of > or = 40% (HR 0.56, 95% CI 0.27-1.13; HR 0.82, 95% CI 0.56-1.22, respectively; interaction P = .34).
  
  
  CONCLUSIONS
  This observational study suggests that beta-blocker treatment is associated with a reduced risk of all-cause mortality among community-dwelling older adults with CHF.
authors.affiliation: Department of Pharmacy, University of Washington, Seattle, Washington, USA. jdchan@u.washington.edu
authors.forename: Jeannie D
authors.initials: JD
authors.lastname: Chan
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Rea
authors.forename: Nicholas L
authors.initials: NL
authors.lastname: Smith
authors.forename: David
authors.initials: D
authors.lastname: Siscovick
authors.forename: Susan R
authors.initials: SR
authors.lastname: Heckbert
authors.forename: Thomas
authors.initials: T
authors.lastname: Lumley
authors.forename: Paulo
authors.initials: P
authors.lastname: Chaves
authors.forename: Curt D
authors.initials: CD
authors.lastname: Furberg
authors.forename: Lewis
authors.initials: L
authors.lastname: Kuller
authors.forename: Bruce M
authors.initials: BM
authors.lastname: Psaty
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality*; D006801:Humans; D008297:Male
chemical_list: D000319:Adrenergic beta-Antagonists