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Comparative effectiveness of beta-blockers in elderly patients with heart failure

Judith M Kramer1, Lesley H Curtis, Carla S Dupree

  • 1Department of Medicine, Duke Clinical Research Institute, Durham, NC 27715, USA. krame009@mc.duke.edu

Archives of Internal Medicine
|December 10, 2008
PubMed

Insights

Beta-blockers (BBs) showed similar survival benefits for heart failure (HF) patients, regardless of type. However, evidence-based BBs (EBBBs) were linked to higher HF rehospitalization rates compared to non-EBBBs.

Area of Science:

  • Cardiology
  • Pharmacology
  • Geriatrics

Background:

  • The effectiveness of beta-blockers (BBs) beyond carvedilol, metoprolol succinate, and bisoprolol fumarate (evidence-based BBs or EBBBs) on survival in heart failure (HF) patients remains unclear.
  • This study aimed to compare the survival outcomes of EBBBs versus non-EBBBs in an elderly HF population.

Purpose of the Study:

  • To evaluate the comparative effectiveness of evidence-based beta-blockers (EBBBs) versus non-EBBBs on 1-year survival in heart failure (HF) patients.
  • To assess secondary outcomes including rehospitalization rates and outpatient visits for HF.

Main Methods:

  • A cohort study of North Carolina residents aged 65+ with HF hospitalizations (2001-2004) using Medicare/Medicaid data.
  • Patients were categorized into three groups: no BBs, EBBBs, or non-EBBBs within 30 days post-discharge.
  • Outcomes were analyzed using inverse probability-weighted (IPW) estimators with propensity score adjustment.

Main Results:

  • Among 11,959 patients, 1-year adjusted mortality rates were 28.3% (no BBs), 22.8% (non-EBBBs), and 24.2% (EBBBs).
  • Both EBBBs and non-EBBBs significantly improved survival compared to no BBs (P = .002 for both), with no significant difference between the two BB groups (P = .43).
  • Patients receiving EBBBs had statistically higher HF rehospitalization rates compared to both no BBs (P = .002) and non-EBBBs (P < .001).

Conclusions:

  • In elderly heart failure patients, evidence-based beta-blockers (EBBBs) and non-EBBBs demonstrated similar 1-year survival effectiveness.
  • The use of EBBBs was associated with a higher rate of rehospitalization for heart failure compared to non-EBBBs.
Abstract

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