Has beta-blocker use increased in patients with heart failure in internal medicine settings? Prognostic implications: RICA registry.
OBJECTIVE
Underuse of beta-blockers has been reported in elderly patients with heart failure. The aim of this study was to evaluate the current prescription of beta-blockers in the internal medicine setting, and its association with morbidity and mortality in heart failure patients.


METHODS
The information analyzed was obtained from a prospective cohort of patients hospitalized for heart failure (RICA registry] database, patients included from March 2008 to September 2011) with at least one year of follow-up. We investigated the percentage of patients prescribed beta-blockers at hospital discharge, and at 3 and 12 months, and the relationship of beta-blocker use with mortality and readmissions for heart failure. Patients with significant valve disease were excluded.


RESULTS
A total of 515 patients were analyzed (53.5% women), with a mean age of 77.1 (8.7) years. Beta-blockers were prescribed in 62.1% of patients at discharge. A similar percentage was found at 3 months (65.6%) and 12 months (67.9%) after discharge. All-cause mortality and the composite of all-cause mortality and readmission for heart failure were significantly lower in patients treated with beta-blockers (hazard ratio=0.59, 95% confidence interval, 0.41-0.84 vs hazard ratio=0.64, 95% confidence interval, 0.49-0.83). This decrease in mortality was maintained after adjusting by age, sex, ejection fraction, functional class, comorbidities, and concomitant treatment.


CONCLUSIONS
The findings of this study indicate that beta-blocker use is increasing in heart failure patients (mainly elderly) treated in the internal medicine setting, and suggest that the use of these drugs is associated with a reduction in clinical events.
Unidad de Insuficiencia Cardiaca y Riesgo Vascular, Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain.
Andrés
A
González-García
Servicio de Medicina Interna, IMIBIC/Hospital Reina Sofía, Universidad de Córdoba, Córdoba, Spain.
Manuel
M
Montero Pérez-Barquero
Unidad de Geriatría, Servicio de Medicina Interna, Hospital Universitari de Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.
Francesc
F
Formiga
Servicio Cardiología y UCC, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain.
José R
JR
González-Juanatey
Servicio de Medicina Interna, Hospital Universitario La Paz, Madrid, Spain.
M Angustias
MA
Quesada
Unidad de Soporte a Urgencias, Hospital Universitari Parc Taulí, Universitat Autònoma de Barcelona, Sabadell, Barcelona, Spain.
Francisco
F
Epelde
Servicio de Medicina Interna, Hospital Can Misses, Ibiza, Balearic Islands, Spain.
Roberto
R
Oropesa
Servicio de Medicina Interna, Hospital Royo Villanova, Zaragoza, Spain.
Jesús
J
Díez-Manglano
Servicio de Medicina Interna, Hospital Universitario Lucus Augusti, Lugo, Spain.
José M
JM
Cerqueiro
Unidad de Insuficiencia Cardiaca y Riesgo Vascular, Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, Spain. Electronic address: luis.manzano@uah.es.
Luis
L
Manzano
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D007388:Internal Medicine; D008297:Male; D010359:Patient Readmission / Q000706:statistics & numerical data; D012042:Registries; D013030:Spain / Q000453:epidemiology
D000319:Adrenergic beta-Antagonists
Anciano; Beta-blocker agents; Bloqueadores beta; Elderly; Heart failure; Insuficiencia cardiaca; RICA registry; Registro RICA; Tratamiento; Treatment