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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
Karolinska Inst, Sweden; ASUITS, Italy.
Karolinska Inst, Sweden; Univ Utrecht, Netherlands; UCL, England.
Karolinska Inst, Sweden.
Karolinska Inst, Sweden; German Ctr Cardiovasc Res DZHK, Germany.
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2019 (English)In: European Journal of Heart Failure, ISSN 1388-9842, E-ISSN 1879-0844Article in journal (Refereed) Epub ahead of print
Abstract [en]

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 amp;gt;= 80 years. Methods and results We included patients with an ejection fraction amp;lt;40% and aged amp;gt;= 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 amp;lt;80 years. A negative control outcome analysis was run using hospitalization for cancer as endpoint. Of 6562 patients aged amp;gt;= 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 amp;lt;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 amp;gt;= 80 years of age, use of beta-blockers was high and was associated with improved all-cause and CV survival.

Place, publisher, year, edition, pages
WILEY , 2019.
Keywords [en]
Heart failure; Elderly; Beta-blocker; SwedeHF; Registry
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:liu:diva-161605DOI: 10.1002/ejhf.1615ISI: 000491952900001PubMedID: 31478583OAI: oai:DiVA.org:liu-161605DiVA, id: diva2:1367941
Note

Funding Agencies|EU/EFPIA Innovative Medicines Initiative 2 Joint Undertaking BigData@Heart grant [116 074]; UCL Hospitals NIHR Biomedical Research Centre

Available from: 2019-11-05 Created: 2019-11-05 Last updated: 2019-11-05

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Dahlström, Ulf
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Division of Cardiovascular MedicineFaculty of Medicine and Health SciencesDepartment of Cardiology in Linköping
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