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Role of High-Dose Beta-Blockers in Patients with Heart Failure with Preserved Ejection Fraction and Elevated Heart Rate
- Source :
- The American Journal of Medicine. 131:1473-1481
- Publication Year :
- 2018
- Publisher :
- Elsevier BV, 2018.
-
Abstract
- Background Beta-blockers in high target doses are recommended for heart failure with reduced ejection fraction (HFrEF) but not for preserved ejection fraction (HFpEF). Treatment benefits are often more pronounced in high-risk subgroups, and patients with HFpEF with heart rate ≥70 beats per minute have emerged as such a high-risk subgroup. We examined the associations of high-dose beta-blocker use with outcomes in these patients. Methods Of the 8462 hospitalized patients with heart failure with ejection fraction ≥50% in the Medicare-linked Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF) registry, 5422 had a discharge heart rate ≥70 beats per minute. Of these, 4537 had no contraindications to beta-blocker use, of which 2797 (2592 with dose data) received prescriptions for beta-blockers. Of the 2592, 730 received high-dose beta-blockers, defined as atenolol ≥100 mg/day, carvedilol ≥50 mg/day, metoprolol tartrate or succinate ≥200 mg/day, or bisoprolol ≥10 mg/day, and 1740 received no beta-blockers. Using propensity scores for the receipt of high-dose beta-blockers, we assembled a matched cohort of 1280 patients, balanced on 58 characteristics. Results All-cause mortality occurred in 63% and 68% of matched patients receiving high-dose beta-blocker vs no beta-blocker, respectively, during 6 years (median, 2.8) of follow-up (hazard ratio, 0.86; 95% confidence interval, 0.75-0.98; P = .027). The hazard ratios (95% confidence intervals) for all-cause readmission and the combined endpoint of all-cause readmission or all-cause mortality associated with high-dose beta-blocker use were 0.90 (0.81-1.02) and 0.89 (0.80-1.00), respectively. Conclusions In patients with HFpEF and heart rate ≥70 beats per minute, high-dose beta-blocker use was associated with a significantly lower risk of death. Future randomized controlled trials are needed to examine this association.
- Subjects :
- medicine.medical_specialty
Adrenergic beta-Antagonists
030204 cardiovascular system & hematology
03 medical and health sciences
0302 clinical medicine
Heart Rate
Internal medicine
Heart rate
medicine
Humans
030212 general & internal medicine
Propensity Score
Carvedilol
Aged
Aged, 80 and over
Heart Failure
Ejection fraction
Dose-Response Relationship, Drug
business.industry
Hazard ratio
Stroke Volume
General Medicine
medicine.disease
Atenolol
Logistic Models
Bisoprolol
Heart failure
Cardiology
Heart failure with preserved ejection fraction
business
medicine.drug
Subjects
Details
- ISSN :
- 00029343
- Volume :
- 131
- Database :
- OpenAIRE
- Journal :
- The American Journal of Medicine
- Accession number :
- edsair.doi.dedup.....489f739313448000dd4af87655c70a07