Relationship between different doses of beta-blockers and prognosis in elderly patients with reduced ejection fraction

Abstract Background Beta-blockers (BBs) remain underused in elderly patients with reduced ejection fraction (REF). Our aim was to determine the prognostic impact of different doses of BB in this setting. Methods and results A single-center observational study was conducted. Inclusion criteria were a...

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Bibliographic Details
Published in:International journal of cardiology 2016-10, Vol.220, p.219-225
Main Authors: Franco-Peláez, Juan Antonio, Cortés-García, Marcelino, Romero-Daza, Angélica María, Martín-Mariscal, María Luisa, García-Ropero, Álvaro, López-Castillo, Marta, Palfy, Julia Anna, Pello-Lázaro, Ana María, Taibo-Urquía, Mikel, Briongos-Figuero, Sem, Farré, Jerónimo
Format: Article
Language:English
Subjects:
Adrenergic beta-Antagonists - administration & dosage
Adrenergic beta-Antagonists - adverse effects
Adrenergic beta-Antagonists - classification
Aged
Aged, 80 and over
Beta-blocker
Cardiovascular
Disease Progression
Dose-Response Relationship, Drug
Elderly
Female
Heart failure
Heart Failure - diagnosis
Heart Failure - drug therapy
Heart Failure - mortality
Heart Failure - physiopathology
Hospitalization - statistics & numerical data
Humans
Left ventricular dysfunction
Male
Prognosis
Propensity Score
Proportional Hazards Models
Risk Assessment - methods
Spain - epidemiology
Stroke Volume - drug effects
Survival Analysis
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Summary:Abstract Background Beta-blockers (BBs) remain underused in elderly patients with reduced ejection fraction (REF). Our aim was to determine the prognostic impact of different doses of BB in this setting. Methods and results A single-center observational study was conducted. Inclusion criteria were age ≥ 75 and EF ≤ 0.35. Six months after diagnosis, patients were divided into 3 groups depending on BB dose: no BB (NBB), low dose (< 50% of the target dose) (LD), and high dose (≥ 50%) (HD). Two different analytical approaches were employed: multivariate Cox model and propensity-score (PS) matching. Outcomes were all-cause death and heart failure (HF) admission. We included 559 patients (134 NBB, 259 LD, and 166 HD) with median follow-up of 29.9 months. There were 212 deaths (NBB: 70 (52.2%); LD: 94 (36.3%); and HD: 48 (28.9%)) and 171 HF admissions (NBB: 42 (31.3%); LD: 85 (32.8%); and HD: 44 (26.5%)). On multivariate analysis, both LD and HD were associated with improved survival, with no differences between them (HD vs. NBB = 0.67, 95% CI = [0.46–0.98], p = 0.037; HD vs. LD = 1.03, 95% CI = [0.72–1.46], p = 0.894; and LD vs. NBB = 0.65, 95% CI = [0.48–0.90], p = 0.009). However, BB therapy failed to show benefits in HF admissions ( p = NS, for each comparison). PS-matched analysis included 198 patients, with similar results to those mentioned above. Conclusions BB therapy was associated with a significant reduction in mortality among elderly patients with REF, regardless of dose. Nevertheless, it was not associated with a decrease in HF admissions. Further studies are needed to determine the optimal BB dose in these patients.
ISSN:0167-5273
1874-1754
DOI:10.1016/j.ijcard.2016.06.178