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
(2019)
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.
ISSN 1879-0844
https://doi.org/10.1002/ejhf.1615
SGUL Authors: Rosano, Giuseppe Massimo Claudio
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Accepted Version
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Abstract
BACKGROUND: Beta-blockers reduce mortality and morbidity in heart failure with reduced ejection fraction (HFrEF). However, patients older than 80 years are poorly represented in randomized controlled trials (RCTs). We assessed the association between beta-blocker use and outcomes in HFrEF patients ≥80 years. METHODS AND RESULTS: We included patients with EF<40%, age ≥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 (PS)-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 6,562 patients aged ≥80 years, 5640 (86%) received beta-blockers. In the matched cohort including 1,732 patients, beta-blocker use was associated with a significant reduction in risk of all-cause mortality (HR: 0.89; 95%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 PS 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. This article is protected by copyright. All rights reserved.
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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. (2019), 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. Accepted Author Manuscript., 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 | ||||||||||||
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Publisher License: | Publisher's own licence | ||||||||||||
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PubMed ID: | 31478583 | ||||||||||||
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URI: | http://sgultest.da.ulcc.ac.uk/id/eprint/111189 | ||||||||||||
Publisher's version: | https://doi.org/10.1002/ejhf.1615 |
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