title: Older adults with heart failure treated with carvedilol, bisoprolol, or metoprolol tartrate: risk of mortality.
abstract: The long-term use of β-blockers has been shown to improve clinical outcomes among patients with heart failure (HF). However, a lack of data persists in assessing whether carvedilol or bisoprolol are superior to metoprolol tartrate in clinical practice. We endeavored to compare the effectiveness of β-blockers among older adults following a primary hospital admission for HF.
  
  
  
  We conducted a cohort study using Quebec administrative databases to identify patients who were using β-blockers, carvedilol, bisoprolol, or metoprolol tartrate after the diagnosis of HF. We characterized the patients by the type of β-blocker prescribed at discharge of their first HF hospitalization. An adjusted multivariate Cox proportional hazards model was used to compare the primary outcome of all-cause mortality. We also conducted analyses by matching for a propensity score for initiation of β-blocker therapy and assessed the effect on primary outcome.
  
  
  
  Among 3197 patients with HF with a median follow-up of 2.8 years, the crude annual mortality rates (per 100 person-years) were at 16, 14.9, and 17.7 for metoprolol tartrate, carvedilol, and bisoprolol, respectively. Adjusted hazard ratios of carvedilol (hazard ratio 0.92; 0.78-1.09) and bisoprolol (hazard ratio 1.04; 0.93-1.16) were not significantly different from that of metoprolol tartrate in improving survival. After matching for propensity score, carvedilol and bisoprolol showed no additional benefit with respect to all-cause mortality compared with metoprolol tartrate.
  
  
  
  Our evidence suggests no differential effect of β-blockers on all-cause mortality among older adults with HF. Copyright © 2016 John Wiley & Sons, Ltd.
authors.affiliation: Faculty of Pharmacy, University of Montreal, Montreal, Quebec, Canada.|University of Montreal, Montreal, Quebec, Canada.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Perreault
authors.affiliation: Faculty of Pharmacy, University of Montreal, Montreal, Quebec, Canada.|University of Montreal, Montreal, Quebec, Canada.|Montreal Heart Institute, Montreal, Quebec, Canada.
authors.forename: Simon
authors.initials: S
authors.lastname: de Denus
authors.affiliation: Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada.|University of Montreal, Montreal, Quebec, Canada.|Montreal Heart Institute, Montreal, Quebec, Canada.
authors.forename: Michel
authors.initials: M
authors.lastname: White
authors.affiliation: Faculty of Pharmacy, University of Montreal, Montreal, Quebec, Canada.|Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada.|University of Montreal, Montreal, Quebec, Canada.
authors.forename: Brian
authors.initials: B
authors.lastname: White-Guay
authors.affiliation: Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada.|University of Montreal, Montreal, Quebec, Canada.
authors.forename: Michel
authors.initials: M
authors.lastname: Bouvier
authors.affiliation: Stats Sciences, University of Montreal, Montreal, Quebec, Canada.
authors.forename: Marc
authors.initials: M
authors.lastname: Dorais
authors.affiliation: Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada.|University of Montreal, Montreal, Quebec, Canada.|Montreal Heart Institute, Montreal, Quebec, Canada.
authors.forename: Marie-Pierre
authors.initials: MP
authors.lastname: Dubé
authors.affiliation: Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada.|University of Montreal, Montreal, Quebec, Canada.|Montreal Heart Institute, Montreal, Quebec, Canada.
authors.forename: Jean-Lucien
authors.initials: JL
authors.lastname: Rouleau
authors.affiliation: Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada.|University of Montreal, Montreal, Quebec, Canada.|Montreal Heart Institute, Montreal, Quebec, Canada.
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Tardif
authors.affiliation: University of Quebec in Montreal, Montreal, Quebec, Canada.
authors.forename: Sarah
authors.initials: S
authors.lastname: Jenna
authors.affiliation: Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.|Department of Medical Biophysics, University of Toronto, Toronto, Canada.|Department of Computer Science, University of Toronto, Toronto, Canada.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Haibe-Kains
authors.affiliation: University of Sherbrooke, Montreal, Quebec, Canada.|Faculty of Medicine, University of Sherbrooke, Quebec, Canada.
authors.forename: Richard
authors.initials: R
authors.lastname: Leduc
authors.affiliation: Faculty of Pharmacy, University of Montreal, Montreal, Quebec, Canada.|University of Montreal, Montreal, Quebec, Canada.
authors.forename: Denis
authors.initials: D
authors.lastname: Deblois
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D017298:Bisoprolol / Q000627:therapeutic use*; D002227:Carbazoles / Q000627:therapeutic use*; D000077261:Carvedilol; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality; D006760:Hospitalization; D006801:Humans; D008297:Male; D008790:Metoprolol / Q000627:therapeutic use*; D011412:Propanolamines / Q000627:therapeutic use*; D057216:Propensity Score; D016016:Proportional Hazards Models; D011792:Quebec; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists; D002227:Carbazoles; D011412:Propanolamines; D000077261:Carvedilol; D008790:Metoprolol; D017298:Bisoprolol
keywords: heart failure; mortality; pharmacoepidemiology; β-blockers