title: Comparison of β-blocker effectiveness in heart failure patients with preserved ejection fraction versus those with reduced ejection fraction.
abstract: BACKGROUND
  The aim of this study was to compare the benefit of beta-blockers (BB) in heart failure (HF) with preserved versus reduced ejection fraction (EF).
  
  
  RESULTS
  This was a retrospective study of insured patients who were hospitalized for HF from January 2000 to June 2008. Pharmacy claims were used to estimate BB exposure over 6-month rolling windows. The association between BB exposure and all-cause hospitalization or death was tested with the use of time-updated proportional hazards regression, with adjustment for baseline covariates and other HF medication exposure. The groups were compared by stratification (EF <50% vs ≥50%) and with the use of an EF-group × BB exposure interaction term. A total of 1,835 patients met the inclusion criteria, 741 (40%) with a preserved EF. Median follow-up was 2.1 years. In a fully adjusted multivariable model, BB exposure was associated with a decreased risk of death or hospitalization in both groups (EF <50%: hazard ratio [HR] 0.53 [P < .0001]; EF ≥50%: HR 0.68 [P = .009]). There was no significant difference in this protective association between groups (interaction: P = .32).
  
  
  CONCLUSIONS
  BB exposure was associated with a similar protective effect regarding time to death or hospitalization in HF patients regardless of whether EF was preserved or reduced. An adequately powered randomized trial of BB in HF with preserved EF is warranted.
authors: Department of Internal Medicine, Henry Ford Hospital, Detroit, Michigan 48202, USA.
authors: Mostafa
authors: M
authors: El-Refai
authors: Edward L
authors: EL
authors: Peterson
authors: Karen
authors: K
authors: Wells
authors: Tanmay
authors: T
authors: Swadia
authors: Hani N
authors: HN
authors: Sabbah
authors: John A
authors: JA
authors: Spertus
authors: L Keoki
authors: LK
authors: Williams
authors: David E
authors: DE
authors: Lanfear
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000494:pharmacology / Q000627:therapeutic use*; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000639:trends*; D012189:Retrospective Studies; D013318:Stroke Volume / Q000187:drug effects* / Q000502:physiology; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists
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