title: Predictors, Trends, and Outcomes (Among Older Patients ≥65 Years of Age) Associated With Beta-Blocker Use in Patients With Stable Angina Undergoing Elective Percutaneous Coronary Intervention: Insights From the NCDR Registry.
abstract: This study sought to examine predictors, trends, and outcomes associated with β-blocker prescriptions at discharge in patients with stable angina without prior history of myocardial infarction (MI) or systolic heart failure (HF) undergoing elective percutaneous coronary intervention (PCI).
  
  
  
  The benefits of β-blockers in patients with MI and/or systolic HF are well established. However, whether β-blockers affect outcomes in patients with stable angina, especially after PCI, remains uncertain.
  
  
  
  We included patients with stable angina without prior history of MI, left ventricular systolic dysfunction (left ventricular ejection fraction <40%) or systolic HF undergoing elective PCI between January 2005 and March 2013 from the hospitals enrolled in the National Cardiovascular Data Registry (NCDR) CathPCI registry. These patients were retrospectively analyzed for predictors and trends of β-blocker prescriptions at discharge. All-cause mortality (primary endpoint), revascularization, or hospitalization related to MI, HF, or stroke at 30-day and 3-year follow-up were analyzed among patients ≥65 years of age.
  
  
  
  A total of 755,215 patients from 1,443 sites were studied, and 71.4% population of our cohort was discharged on β-blockers. At 3-year follow-up among patients ≥65 years of age with CMS data linkage (16.3% of the studied population), there was no difference in adjusted mortality rate (14.0% vs. 13.3%; adjusted hazard ratio [HR]: 1.00; 95% confidence interval [CI]: 0.96 to 1.03; p = 0.84), MI (4.2% vs. 3.9%; adjusted HR: 1.00; 95% CI: 0.93 to 1.07; p = 0.92), stroke (2.3% vs. 2.0%; adjusted HR: 1.08; 95% CI: 0.98 to 1.18; p = 0.14) or revascularization (18.2% vs. 17.8%; adjusted HR: 0.97; 95% CI: 0.94 to 1.01; p = 0.10) with β-blocker prescription. However, discharge on β-blockers was associated with more HF readmissions at 3-year follow-up (8.0% vs. 6.1%; adjusted HR: 1.18; 95% CI: 1.12 to 1.25; p < 0.001). Results at 30-day follow-up were broadly consistent as well. During the period between 2005 and 2013, there was a gradual increase in prescription of β-blockers at the index discharge in our cohort (p < 0.001).
  
  
  
  Among patients ≥65 years of age with history of stable angina without prior MI, systolic HF or left ventricular ejection fraction <40% undergoing elective PCI, β-blocker use at discharge was not associated with any reduction in cardiovascular morbidity or mortality at 30-day and at 3-year follow-up. Over time, β-blockers use at discharge in this population has continued to increase.
authors.affiliation: Division of Cardiology, Columbia University, New York, New York.
authors.forename: Apurva A
authors.initials: AA
authors.lastname: Motivala
authors.affiliation: Division of Cardiology, Department of Medicine, Staten Island University Hospital, Staten Island, New York. Electronic address: valayparikh@gmail.com.
authors.forename: Valay
authors.initials: V
authors.lastname: Parikh
authors.affiliation: Duke Clinical Research Institute/Duke University Medical Center, Durham, North Carolina.
authors.forename: Matthew
authors.initials: M
authors.lastname: Roe
authors.affiliation: Duke Clinical Research Institute/Duke University Medical Center, Durham, North Carolina.
authors.forename: David
authors.initials: D
authors.lastname: Dai
authors.affiliation: Division of Cardiology, Warren Alpert Medical School, Brown University, Providence, Rhode Island.
authors.forename: J Dawn
authors.initials: JD
authors.lastname: Abbott
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota; St. George's, University of London, London, United Kingdom.
authors.forename: Abhiram
authors.initials: A
authors.lastname: Prasad
authors.affiliation: Division of Cardiology, Texas Tech University Health Sciences Center, El Paso, Texas.
authors.forename: Debabrata
authors.initials: D
authors.lastname: Mukherjee
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D000367:Age Factors; D000368:Aged; D060050:Angina, Stable / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D016009:Chi-Square Distribution; D011307:Drug Prescriptions; D005260:Female; D006333:Heart Failure / Q000209:etiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000209:etiology; D016017:Odds Ratio; D010351:Patient Discharge / Q000639:trends; D010359:Patient Readmission; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality / Q000639:trends*; D010818:Practice Patterns, Physicians' / Q000639:trends*; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
chemical_list: D000319:Adrenergic beta-Antagonists
keywords: percutaneous coronary intervention; stable angina; β-blockers