title: Relationship between recommended chronic heart failure treatments and mortality over 8 years in real-world conditions: a pharmacoepidemiological study.
abstract: OBJECTIVE
  We previously reported that chronic heart failure (CHF) treatments reduce the duration of hospitalisation, even in elderly patients. The present study aimed to determine whether CHF treatment also provides long-term benefits in terms of reduced mortality at 8 years.
  
  
  METHODS
  A cohort of 281 patients who were admitted to a French teaching hospital with a main diagnosis of CHF were followed through the health insurance databases for 1 year and through the national mortality database for 8 years.
  
  
  RESULTS
  Diuretics (236 patients, 84 %) and angiotensin-converting enzyme (ACE) inhibitors (193 patients, 69 %) were the most-frequently prescribed medications. The median duration of survival was 46 months. Mortality rates were significantly lower for patients administered beta-blockers (59 %) and statins (56 %) than for patients not exposed to these drugs (82 %, p < 0.001 and 78 %, p = 0.001 respectively). No significant differences in mortality were observed for spironolactone, diuretics or ACE inhibitors. After adjustment, beta-blocker treatment remained associated with a significantly lower risk of mortality (hazard ratio, HR = 0.54 [0.34-0.84]). After adjustment, the use of two or three CHF drugs was associated with longer survival (HR = 0.53 [0.36-0.77]) than the use of zero or one CHF drug. Statins were also associated with longer survival after adjustment (HR = 0.53 [0.31-0.89]). In patients 75 years of age or older (n = 73), only beta-blocker treatment was associated with a significantly lower risk of mortality (HR = 0.31 [0.16-0.63]) in multivariate analysis.
  
  
  CONCLUSIONS
  The use of beta-blockers was associated with better survival rates. The use of statins was also associated with better survival at 8 years. Randomised controlled trials are required to confirm these observations.
authors.affiliation: Service de Pharmacologie Clinique, AP-HP, Hôpital H. Mondor-A. Chenevier, Créteil 94000, France. patrick.maison@hmn.aphp.fr
authors.forename: Patrick
authors.initials: P
authors.lastname: Maison
authors.forename: Gaelle
authors.initials: G
authors.lastname: Desamericq
authors.forename: François
authors.initials: F
authors.lastname: Hemery
authors.forename: Nicole
authors.initials: N
authors.lastname: Elie
authors.forename: Aldo
authors.initials: A
authors.lastname: Del'volgo
authors.forename: Jean Luc
authors.initials: JL
authors.lastname: Dubois-Randé
authors.forename: Luc
authors.initials: L
authors.lastname: Hittinger
authors.forename: Isabelle
authors.initials: I
authors.lastname: Macquin-Mavier
mesh_terms: D000368:Aged; D002908:Chronic Disease; D016208:Databases, Factual; D018572:Disease-Free Survival; D017723:Drug Utilization Review; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006333:Heart Failure / Q000188:drug therapy / Q000401:mortality; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D009026:Mortality / Q000639:trends; D017891:Pharmacoepidemiology; D017410:Practice Guidelines as Topic