Beta-blockers in older patients with heart failure and preserved ejection fraction: class, dosage, and outcomes.
BACKGROUND
We examined the clinical effectiveness of beta-blockers considered evidenced-based to heart failure and reduced ejection fraction (HFrEF) and their recommended target doses in older adults with HF and preserved ejection fraction (HFpEF).


METHODS
In OPTIMIZE-HF (2003-2004) linked to Medicare (2003-2008), of the 10,570 older (age ≥ 65 years, mean, 81 years) adults with HFpEF (EF ≥ 40%, mean 55%), 8373 had no contraindications to beta-blocker therapy. After excluding 4614 patients receiving pre-admission beta-blockers, the remaining 3759 patients were potentially eligible for new discharge prescriptions for beta-blockers and 1454 received them. We assembled a propensity-matched cohort of 1099 pairs of patients receiving beta-blockers and no beta-blockers, balanced on 115 baseline characteristics. Evidence-based beta-blockers for HFrEF, namely, carvedilol, metoprolol succinate, and bisoprolol and their respective guideline-recommended target doses were 50, 200, and 10mg/day.


RESULTS
During 6 years of follow-up, new discharge prescriptions for beta-blockers had no association with the primary composite endpoint of all-cause mortality or HF rehospitalization (hazard ratio, 1.03; 95% confidence interval {CI}, 0.94-1.13; p=0.569). This association did not vary by beta-blocker evidence class or daily dose. Hazard ratios for all-cause mortality and HF rehospitalization were 0.99 (95% CI, 0.90-1.10; p=0.897) and 1.17 (95% CI, 1.03-1.34; p=0.014), respectively. The latter association lost significance when higher EF cutoffs of ≥45%, ≥50% and ≥55% were used.


CONCLUSIONS
Initiation of therapy with beta-blockers considered evidence-based for HFrEF and in target doses recommended for HFrEF had no association with the composite or individual endpoints of all-cause mortality or HF rehospitalization in HFpEF.
University of California, San Francisco, CA, United States.
Kanan
K
Patel
University of California, Los Angeles, CA, United States.
Gregg C
GC
Fonarow
Meharry Medical College, Nashville, TN, United States.
O James
OJ
Ekundayo
University of Alabama at Birmingham, Birmingham, AL, United States.
Inmaculada B
IB
Aban
University of Alabama at Birmingham, Birmingham, AL, United States.
Meredith L
ML
Kilgore
Case Western Reserve University, Cleveland, OH, United States.
Thomas E
TE
Love
Wake Forest School of Medicine, Winston-Salem, NC, United States.
Dalane W
DW
Kitzman
Northwestern University, Chicago, IL, United States.
Mihai
M
Gheorghiade
Department of Veterans Affairs, Geriatrics and Extended Care Services, Washington, DC, United States.
Richard M
RM
Allman
University of Alabama at Birmingham, Birmingham, AL, United States; Veterans Affairs Medical Center, Birmingham, AL, United States. Electronic address: aahmed@uab.edu.
Ali
A
Ahmed
D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage* / Q000145:classification*; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D018592:Cross-Over Studies; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D008297:Male; D012042:Registries; D013318:Stroke Volume / Q000187:drug effects* / Q000502:physiology; D016896:Treatment Outcome
D000319:Adrenergic beta-Antagonists
Beta-blockers; Heart failure; Preserved ejection fraction