Calcium channel blockers and outcomes in older patients with heart failure and preserved ejection fraction
Kanan Patel1, Gregg C Fonarow1, Momanna Ahmed1
1From the Department of Medicine, University of California, San Francisco (K.P.); Division of Cardiology, University of California, Los Angeles (G.C.F.); Comprehensive Center for Healthy Aging (M.A.), Department of Biostatistics (C.M.) and Department of Health Care Organization and Policy (M.K.), School of Public Health, University of Alabama at Birmingham (M.A., C.M., M.K.); Department of Medicine, Case Western Reserve University, Cleveland, OH (T.E.L.); Department of Medicine, University of California, San Francisco, Fresno (P.D.); Department of Medicine, New York Medical College, Valhalla, NY (W.S.A.); Department of Innovative Clinical Trials, University Medical Centre Göttingen, Göttingen, Germany (S.D.A.); Center for Health and Aging, Veterans Affairs Medical Center, Washington, DC (A.A.).
Insights
New prescriptions for calcium channel blockers (CCBs) in older heart failure patients showed no association with mortality or heart failure hospitalizations. This finding applies regardless of CCB class, offering clarity on their use in this population.
Area of Science:
- Cardiology
- Pharmacology
- Geriatrics
Background:
- Limited understanding of calcium channel blocker (CCB) effects on outcomes in heart failure with preserved ejection fraction (HFpEF).
- Need for evidence-based guidance on CCB use in elderly HFpEF patients.
Purpose of the Study:
- To investigate the association between new CCB prescriptions and clinical outcomes in hospitalized older patients with HFpEF.
- To evaluate the impact of CCBs on mortality and heart failure hospitalizations in this specific patient group.
Main Methods:
- Retrospective analysis of 10,570 hospitalized patients with HFpEF (age ≥65, EF ≥40%) from the OPTIMIZE-HF registry linked to Medicare data.
- Propensity score matching created a cohort of 1620 patients (810 pairs) initiating CCBs versus those not.
- Primary composite endpoint: all-cause mortality or heart failure hospitalization. Secondary endpoints included individual components and all-cause hospitalization.
Main Results:
- In the matched cohort, 82% of patients receiving CCBs and 81% not receiving CCBs experienced the primary composite endpoint (HR 1.03; 95% CI 0.92-1.14).
- No significant associations were found for CCB use with all-cause mortality (HR 1.05; 95% CI 0.94-1.18), heart failure hospitalization (HR 1.05; 95% CI 0.91-1.21), or all-cause hospitalization (HR 1.03; 95% CI 0.93-1.14).
- Similar results were observed for amlodipine and non-amlodipine CCBs, and in pre-match analyses.
Conclusions:
- New discharge prescriptions for CCBs in hospitalized older patients with heart failure were not associated with composite or individual endpoints of mortality or heart failure hospitalization.
- These findings suggest CCBs do not alter major adverse events in this population, irrespective of CCB class.
Background:
Little is known about associations of calcium channel blockers (CCBs) with outcomes in patients with heart failure and preserved ejection fraction (EF).
Methods And Results:
Of the 10 570 hospitalized patients with heart failure and preserved EF, ≥65 years, EF ≥40%, in the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF; 2003-2004), linked to Medicare data (through December 31, 2008), 7514 had no prior history of CCB use. Of these, 815 (11%) patients received new discharge prescriptions for CCBs. Propensity scores for CCB initiation, calculated for each of the 7514 patients, were used to assemble a matched cohort of 1620 (810 pairs) patients (mean age, 80 years; mean EF, 56%; 65% women; 10% black) receiving and not receiving CCBs, balanced on 114 baseline characteristics. The primary composite end point of all-cause mortality or heart failure hospitalization occurred in 82% and 81% of patients receiving and not receiving CCBs (hazard ratio for CCBs, 1.03; 95% confidence interval, 0.92-1.14). Hazard ratios (95% confidence intervals) for all-cause mortality, heart failure hospitalization, and all-cause hospitalization were 1.05 (0.94-1.18), 1.05 (0.91-1.21), and 1.03 (0.93-1.14), respectively. Similar associations were observed when we categorized patients into those receiving amlodipine and nonamlodipine CCBs. Among 7514 prematch patients, multivariable-adjusted and propensity-adjusted hazard ratios (95% confidence interval) for primary composite end point were 1.03 (0.95-1.12) and 1.02 (0.94-1.11), respectively.
Conclusions:
In hospitalized older patients with heart failure, new discharge prescriptions for CCBs had no associations with composite or individual end points of mortality or heart failure hospitalization, regardless of the class of CCBs.
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