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Association between beta‐blocker use and mortality/morbidity in older patients with heart failure with reduced ejection fraction. A propensity score‐matched analysis from the Swedish Heart Failure Registry

Stolfo, D; Uijl, A; Benson, L; Schrage, B; Fudim, M; Asselbergs, FW; Koudstaal, S; Sinagra, G; Dahlström, U; Rosano, G; et al. Stolfo, D; Uijl, A; Benson, L; Schrage, B; Fudim, M; Asselbergs, FW; Koudstaal, S; Sinagra, G; Dahlström, U; Rosano, G; Savarese, G (2020) Association between beta‐blocker use and mortality/morbidity in older patients with heart failure with reduced ejection fraction. A propensity score‐matched analysis from the Swedish Heart Failure Registry. Eur J Heart Fail, 22 (1). pp. 103-112. ISSN 1879-0844 https://doi.org/10.1002/ejhf.1615
SGUL Authors: Rosano, Giuseppe Massimo Claudio

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Abstract

Background Beta‐blockers reduce mortality and morbidity in heart failure (HF) with reduced ejection fraction (HFrEF). However, patients older than 80 years are poorly represented in randomized controlled trials. We assessed the association between beta‐blocker use and outcomes in HFrEF patients aged ≥80 years. Methods and results We included patients with an ejection fraction <40% and aged ≥80 years from the Swedish HF Registry. The association between beta‐blocker use, all‐cause mortality and cardiovascular (CV) mortality/HF hospitalization was assessed by Cox proportional hazard models in a 1:1 propensity score‐matched cohort. To assess consistency, the same analyses were performed in a positive control cohort with age <80 years. A negative control outcome analysis was run using hospitalization for cancer as endpoint. Of 6562 patients aged ≥80 years, 5640 (86%) received beta‐blockers. In the matched cohort including 1732 patients, beta‐blocker use was associated with a significant reduction in the risk of all‐cause mortality [hazard ratio (HR) 0.89, 95% confidence interval (CI) 0.79–0.99]. Reduction in CV mortality/HF hospitalization was not significant (HR 0.94, 95% CI 0.85–1.05) due to the lack of association with HF hospitalization, whereas CV death was significantly reduced. After adjustment rather than matching for the propensity score in the overall cohort, beta‐blocker use was associated with reduced risk of all outcomes. In patients aged <80 years, use of beta‐blockers was associated with reduced risk of all‐cause death (HR 0.79, 95% CI 0.68–0.92) and of the composite outcome (HR 0.88, 95% CI 0.77–0.99). Conclusions In HFrEF patients ≥80 years of age, use of beta‐blockers was high and was associated with improved all‐cause and CV survival.

Item Type: Article
Additional Information: This is the peer reviewed version of the following article: Stolfo, D., Uijl, A., Benson, L., Schrage, B., Fudim, M., Asselbergs, F.W., Koudstaal, S., Sinagra, G., Dahlström, U., Rosano, G. and Savarese, G. (2020), Association between beta‐blocker use and mortality/morbidity in older patients with heart failure with reduced ejection fraction. A propensity score‐matched analysis from the Swedish Heart Failure Registry. Eur J Heart Fail, 22: 103-112, which has been published in final form at https://doi.org/10.1002/ejhf.1615. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.
Keywords: Beta-blocker, Elderly, Heart Failure, Registry, SwedeHF, 1102 Cardiovascular Medicine And Haematology, Cardiovascular System & Hematology
SGUL Research Institute / Research Centre: Academic Structure > Molecular and Clinical Sciences Research Institute (MCS)
Journal or Publication Title: Eur J Heart Fail
ISSN: 1879-0844
Language: eng
Dates:
DateEvent
30 January 2020Published
23 October 2019Published Online
20 August 2019Accepted
Publisher License: Publisher's own licence
Projects:
Project IDFunderFunder ID
116074EU/EFPIA Innovative Medicines InitiativeUNSPECIFIED
17MCPRP33460225American Heart Associationhttp://dx.doi.org/10.13039/100000968
5T32HL007101-42National Heart, Lung, and Blood Institutehttp://dx.doi.org/10.13039/100000050
PubMed ID: 31478583
Go to PubMed abstract
URI: http://openaccess.sgul.ac.uk/id/eprint/111189
Publisher's version: https://doi.org/10.1002/ejhf.1615

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