Prescription of beta-blockers in patients with advanced heart failure and preserved left ventricular ejection fraction. Clinical implications and survival.
BACKGROUND
The effects of beta-blockers in patients with heart failure (HF) and preserved left ventricular ejection fraction (LVEF) are not well established.


OBJECTIVE
To assess the association between beta-blocker prescription at discharge and mortality in a cohort of patients with advanced HF and preserved LVEF.


RESULTS
We prospectively studied a cohort of 443 patients with advanced HF and preserved LVEF (LVEF> or =40%). Mean age was 78 years, 56% female, 33% NYHA class IV. Overall, 227 patients (51%) had a beta-blocker prescribed at discharge. Mean duration of follow-up was 25 (+/-18) months. Death (all cause) occurred in 40 patients (17.6%) who were receiving a beta-blocker at discharge and 73 patients (33.8%) who were not on a beta-blocker. In multivariate Cox analysis, including adjustment for propensity score, prescription of a beta-blocker remained associated with a 43% relative mortality risk reduction (HR 0.57, 95% CI 0.37 to 0.88, p=0.01).


CONCLUSIONS
In this cohort of patients with advanced HF and preserved LVEF, prescription of a beta-blocker was associated with a significant mortality reduction. This beneficial effect of beta-blocker use needs to be further confirmed in prospective, randomised clinical trials.
Dobre
Daniela
D
Northern Centre for Healthcare Research, University Medical Centre Groningen, University of Groningen, The Netherlands. d.dobre@med.umcg.nl <d.dobre@med.umcg.nl>
van Veldhuisen
Dirk J
DJ
DeJongste
Mike J L
MJ
Lucas
Carolien
C
Cleuren
Ger
G
Sanderman
Robbert
R
Ranchor
Adelita V
AV
Haaijer-Ruskamp
Flora M
FM
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D000369:Aged, 80 and over; D004812:Epidemiologic Methods; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D018579:Patient Selection; D013318:Stroke Volume / Q000502:physiology; D016896:Treatment Outcome
D000319:Adrenergic beta-Antagonists