Heart failure in community practice: relationship to age and sex in a beta-blocker registry.
Women and the elderly are underrepresented in clinical trials of heart failure (HF). The authors analyzed, by sex and age groups, a registry of 4280 community patients initiating carvedilol for HF. Women (n=1485) were older than men (n=2793) and had worse functional class with higher left ventricular ejection fraction and blood pressure. Women also had more HF hospitalizations, less use of angiotensin-converting enzyme inhibitors, and lower doses of carvedilol. Nevertheless, during 1-year follow-up, both groups experienced greater than 40% reductions in HF hospitalizations (P<.001), with mortality of 7.3% in women vs 9.1% in men (P=.085). With increasing age, left ventricular ejection fraction, blood pressure, and functional class increased, whereas angiotensin-converting enzyme inhibitor use and carvedilol doses decreased. HF hospitalizations fell at least 40% in all age groups after starting carvedilol (P<.001). Characteristics of women and the elderly with HF in the community suggest increased risk, but both populations respond well after initiating carvedilol.
Franciosa
Joseph A
JA
Zena and Michael A. Wiener Cardiovascular Institute, Mt Sinai School of Medicine, and the Weill Medical College of Cornell University, New York, NY, USA. josephafranciosa@aol.com
Nelson
Jeanenne J
JJ
Lukas
Mary Ann
MA
Lottes
Sandra R
SR
Massie
Barry M
BM
Fowler
Michael B
MB
Greenberg
Barry
B
Gilbert
Edward M
EM
Abraham
William T
WT
D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D000367:Age Factors; D000368:Aged; D002227:Carbazoles / Q000008:administration & dosage / Q000627:therapeutic use*; D000077261:Carvedilol; D015897:Comorbidity; D018450:Disease Progression; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011412:Propanolamines / Q000008:administration & dosage / Q000627:therapeutic use*; D012042:Registries; D012737:Sex Factors; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000453:epidemiology
D000319:Adrenergic beta-Antagonists; D002227:Carbazoles; D011412:Propanolamines; D000077261:Carvedilol