Do cardioselective beta-adrenoceptor antagonists reduce mortality in diabetic patients with congestive heart failure?
BACKGROUND
The relative benefits of cardioselective beta-adrenoceptor antagonists (CSB) among patients with congestive heart failure (CHF) and diabetes mellitus are not firmly established.


OBJECTIVE
To determine whether diabetic patients with CHF accrue the same mortality benefit from CSB therapy as non-diabetic patients.


METHODS
Between October 1999 and November 2000 consecutive patients with CHF at the Veteran's Affairs Medical Center in Indianapolis, IN, USA, were enrolled in a randomized controlled trial and prospectively followed for 5 years. Disease severity and CHF-specific functional status were obtained from patients at baseline. Medical records were accessed for data regarding co-morbidities, medications, and mortality. Propensity-score analysis was used to balance co-variates because of the observational nature of CSB use, given this was a post hoc analysis. A multivariate Cox proportional hazards model was used to compare survival between diabetic and non-diabetic patients stratified by whether they were or were not receiving CSB therapy.


RESULTS
Of the 412 evaluable patients, 222 (54%) had diabetes and 212 (51%) were taking a CSB. At 5-year follow-up, 186 (45%) patients had died. In the multivariate analysis, using propensity scores to balance co-variates, CSB therapy was an independent predictor of survival in patients without diabetes (hazard ratio 0.60; p = 0.054) only.


CONCLUSIONS
These results extend prior observations that patients with diabetes and CHF may not accrue the same mortality benefit from CSB therapy as patients without diabetes, and warrant further prospective investigation.
Subramanian
Usha
U
Krannert Institute of Cardiology and Roudebush Veterans Affairs Medical Center, Indiana University Medical Center, Indianapolis, Indiana 46202, USA.
Kamalesh
Masoor
M
Temkit
M'hamed
M
Eckert
George J
GJ
Sawada
Stephen
S
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D048909:Diabetes Complications / Q000401:mortality*; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D011446:Prospective Studies; D018570:Risk Assessment; D015996:Survival Rate
D000319:Adrenergic beta-Antagonists