SORA

Advancing, promoting and sharing knowledge of health through excellence in teaching, clinical practice and research into the prevention and treatment of illness

Effect of age and sex on efficacy and tolerability of β blockers in patients with heart failure with reduced ejection fraction: individual patient data meta-analysis.

Kotecha, D; Manzano, L; Krum, H; Rosano, G; Holmes, J; Altman, DG; Collins, PD; Packer, M; Wikstrand, J; Coats, AJS; et al. Kotecha, D; Manzano, L; Krum, H; Rosano, G; Holmes, J; Altman, DG; Collins, PD; Packer, M; Wikstrand, J; Coats, AJS; Cleland, JGF; Kirchhof, P; von Lueder, TG; Rigby, AS; Andersson, B; Lip, GYH; van Veldhuisen, DJ; Shibata, MC; Wedel, H; Böhm, M; Flather, MD; Beta-Blockers in Heart Failure Collaborative Group (2016) Effect of age and sex on efficacy and tolerability of β blockers in patients with heart failure with reduced ejection fraction: individual patient data meta-analysis. BMJ, 353. i1855. ISSN 1756-1833 https://doi.org/10.1136/bmj.i1855
SGUL Authors: Rosano, Giuseppe Massimo Claudio

[img]
Preview
PDF Published Version
Available under License Creative Commons Attribution.

Download (620kB) | Preview

Abstract

OBJECTIVES: To determine the efficacy and tolerability of β blockers in a broad age range of women and men with heart failure with reduced ejection fraction (HFrEF) by pooling individual patient data from placebo controlled randomised trials. DESIGN: Prospectively designed meta-analysis of individual patient data from patients aged 40-85 in sinus rhythm at baseline, with left ventricular ejection fraction <0.45. PARTICIPANTS: 13,833 patients from 11 trials; median age 64; 24% women. MAIN OUTCOME MEASURES: The primary outcome was all cause mortality; the major secondary outcome was admission to hospital for heart failure. Analysis was by intention to treat with an adjusted one stage Cox proportional hazards model. RESULTS: Compared with placebo, β blockers were effective in reducing mortality across all ages: hazard ratios were 0.66 (95% confidence interval 0.53 to 0.83) for the first quarter of age distribution (median age 50); 0.71 (0.58 to 0.87) for the second quarter (median age 60); 0.65 (0.53 to 0.78) for the third quarter (median age 68); and 0.77 (0.64 to 0.92) for the fourth quarter (median age 75). There was no significant interaction when age was modelled continuously (P=0.1), and the absolute reduction in mortality was 4.3% over a median follow-up of 1.3 years (number needed to treat 23). Admission to hospital for heart failure was significantly reduced by β blockers, although this effect was attenuated at older ages (interaction P=0.05). There was no evidence of an interaction between treatment effect and sex in any age group. Drug discontinuation was similar regardless of treatment allocation, age, or sex (14.4% in those give β blockers, 15.6% in those receiving placebo). CONCLUSION: Irrespective of age or sex, patients with HFrEF in sinus rhythm should receive β blockers to reduce the risk of death and admission to hospital.Registration PROSPERO CRD42014010012; Clinicaltrials.gov NCT00832442.

Item Type: Article
Additional Information: This is an Open Access article distributed in accordance with the Creative Commons Attribution (CC BY 3.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/3.0/.
Keywords: Adrenergic beta-Antagonists, Adult, Age Factors, Aged, Aged, 80 and over, Female, Heart Failure, Humans, Male, Middle Aged, Sex Factors, Stroke Volume, Treatment Outcome, Beta-Blockers in Heart Failure Collaborative Group, Humans, Adrenergic beta-Antagonists, Stroke Volume, Treatment Outcome, Age Factors, Sex Factors, Adult, Aged, Aged, 80 and over, Middle Aged, Female, Male, Heart Failure
SGUL Research Institute / Research Centre: Academic Structure > Molecular and Clinical Sciences Research Institute (MCS)
Journal or Publication Title: BMJ
ISSN: 1756-1833
Language: eng
Dates:
DateEvent
20 April 2016Published
14 March 2016Accepted
Publisher License: Creative Commons: Attribution 3.0
Projects:
Project IDFunderFunder ID
CDF-2015-08-074Department of Healthhttp://dx.doi.org/10.13039/501100000276
FS/13/43/30324British Heart Foundationhttp://dx.doi.org/10.13039/501100000274
PubMed ID: 27098105
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/111197
Publisher's version: https://doi.org/10.1136/bmj.i1855

Actions (login required)

Edit Item Edit Item