title: Relationship between different doses of beta-blockers and prognosis in elderly patients with reduced ejection fraction.
abstract: BACKGROUND
  Beta-blockers (BBs) remain underused in elderly patients with reduced ejection fraction (REF). Our aim was to determine the prognostic impact of different doses of BB in this setting.
  
  
  RESULTS
  A single-center observational study was conducted. Inclusion criteria were age≥75 and EF≤0.35. Six months after diagnosis, patients were divided into 3 groups depending on BB dose: no BB (NBB), low dose (<50% of the target dose) (LD), and high dose (≥50%) (HD). Two different analytical approaches were employed: multivariate Cox model and propensity-score (PS) matching. Outcomes were all-cause death and heart failure (HF) admission. We included 559 patients (134 NBB, 259 LD, and 166 HD) with median follow-up of 29.9months. There were 212 deaths (NBB: 70 (52.2%); LD: 94 (36.3%); and HD: 48 (28.9%)) and 171 HF admissions (NBB: 42 (31.3%); LD: 85 (32.8%); and HD: 44 (26.5%)). On multivariate analysis, both LD and HD were associated with improved survival, with no differences between them (HD vs. NBB=0.67, 95% CI=[0.46-0.98], p=0.037; HD vs. LD=1.03, 95% CI=[0.72-1.46], p=0.894; and LD vs. NBB=0.65, 95% CI=[0.48-0.90], p=0.009). However, BB therapy failed to show benefits in HF admissions (p=NS, for each comparison). PS-matched analysis included 198 patients, with similar results to those mentioned above.
  
  
  CONCLUSIONS
  BB therapy was associated with a significant reduction in mortality among elderly patients with REF, regardless of dose. Nevertheless, it was not associated with a decrease in HF admissions. Further studies are needed to determine the optimal BB dose in these patients.
authors.affiliation: Department of Cardiology, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Madrid, Spain. Electronic address: jafrancope@yahoo.es.
authors.forename: Juan Antonio
authors.initials: JA
authors.lastname: Franco Peláez
authors.affiliation: Department of Cardiology, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Madrid, Spain.
authors.forename: Marcelino
authors.initials: M
authors.lastname: Cortés García
authors.affiliation: Department of Cardiology, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Madrid, Spain.
authors.forename: Angélica María
authors.initials: AM
authors.lastname: Romero Daza
authors.affiliation: Department of Cardiology, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Madrid, Spain.
authors.forename: María Luisa
authors.initials: ML
authors.lastname: Martín Mariscal
authors.affiliation: Department of Cardiology, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Madrid, Spain.
authors.forename: Álvaro
authors.initials: Á
authors.lastname: García Ropero
authors.affiliation: Department of Cardiology, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Madrid, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: López Castillo
authors.affiliation: Department of Cardiology, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Madrid, Spain.
authors.forename: Julia Anna
authors.initials: JA
authors.lastname: Palfy
authors.affiliation: Department of Cardiology, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Madrid, Spain.
authors.forename: Ana María
authors.initials: AM
authors.lastname: Pello Lázaro
authors.affiliation: Department of Cardiology, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Madrid, Spain.
authors.forename: Mikel
authors.initials: M
authors.lastname: Taibo Urquía
authors.affiliation: Department of Cardiology, Hospital Infanta Leonor, Madrid, Spain.
authors.forename: Sem
authors.initials: S
authors.lastname: Briongos Figuero
authors.affiliation: Department of Cardiology, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Madrid, Spain.
authors.forename: Jerónimo
authors.initials: J
authors.lastname: Farré
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage / Q000009:adverse effects / Q000145:classification; D000368:Aged; D000369:Aged, 80 and over; D018450:Disease Progression; D004305:Dose-Response Relationship, Drug; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D011379:Prognosis; D057216:Propensity Score; D016016:Proportional Hazards Models; D018570:Risk Assessment / Q000379:methods; D013030:Spain / Q000453:epidemiology; D013318:Stroke Volume / Q000187:drug effects*; D016019:Survival Analysis
chemical_list: D000319:Adrenergic beta-Antagonists
keywords: Beta-blocker; Elderly; Heart failure; Left ventricular dysfunction