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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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| Published in: | International journal of cardiology 2016-10, Vol.220, p.219-225 |
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| creator | 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 |
| description | 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. |
| doi_str_mv | 10.1016/j.ijcard.2016.06.178 |
| format | article |
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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.</description><identifier>ISSN: 0167-5273</identifier><identifier>EISSN: 1874-1754</identifier><identifier>DOI: 10.1016/j.ijcard.2016.06.178</identifier><identifier>PMID: 27389445</identifier><language>eng</language><publisher>Netherlands: Elsevier Ireland Ltd</publisher><subject>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</subject><ispartof>International journal of cardiology, 2016-10, Vol.220, p.219-225</ispartof><rights>2016 Elsevier Ireland Ltd</rights><rights>Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c417t-31259189ec92b5a8ba1a6473b5dcfe7a1a6e5c05f09792607aaf3431f5a57aca3</citedby><cites>FETCH-LOGICAL-c417t-31259189ec92b5a8ba1a6473b5dcfe7a1a6e5c05f09792607aaf3431f5a57aca3</cites><orcidid>0000-0001-5360-7066</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,786,790,27957,27958</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27389445$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Franco-Peláez, Juan Antonio</creatorcontrib><creatorcontrib>Cortés-García, Marcelino</creatorcontrib><creatorcontrib>Romero-Daza, Angélica María</creatorcontrib><creatorcontrib>Martín-Mariscal, María Luisa</creatorcontrib><creatorcontrib>García-Ropero, Álvaro</creatorcontrib><creatorcontrib>López-Castillo, Marta</creatorcontrib><creatorcontrib>Palfy, Julia Anna</creatorcontrib><creatorcontrib>Pello-Lázaro, Ana María</creatorcontrib><creatorcontrib>Taibo-Urquía, Mikel</creatorcontrib><creatorcontrib>Briongos-Figuero, Sem</creatorcontrib><creatorcontrib>Farré, Jerónimo</creatorcontrib><title>Relationship between different doses of beta-blockers and prognosis in elderly patients with reduced ejection fraction</title><title>International journal of cardiology</title><addtitle>Int J Cardiol</addtitle><description>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.</description><subject>Adrenergic beta-Antagonists - administration & dosage</subject><subject>Adrenergic beta-Antagonists - adverse effects</subject><subject>Adrenergic beta-Antagonists - classification</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Beta-blocker</subject><subject>Cardiovascular</subject><subject>Disease Progression</subject><subject>Dose-Response Relationship, Drug</subject><subject>Elderly</subject><subject>Female</subject><subject>Heart failure</subject><subject>Heart Failure - diagnosis</subject><subject>Heart Failure - drug therapy</subject><subject>Heart Failure - mortality</subject><subject>Heart Failure - physiopathology</subject><subject>Hospitalization - statistics & numerical data</subject><subject>Humans</subject><subject>Left ventricular dysfunction</subject><subject>Male</subject><subject>Prognosis</subject><subject>Propensity Score</subject><subject>Proportional Hazards Models</subject><subject>Risk Assessment - methods</subject><subject>Spain - epidemiology</subject><subject>Stroke Volume - drug effects</subject><subject>Survival Analysis</subject><issn>0167-5273</issn><issn>1874-1754</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><recordid>eNqFkU1v1DAQhi0EotvCP0DIRy4JniSOkwsSqvioVAmJD4mb5dhj6tRrL3bSav89Dls4cOFkz8w779jPEPICWA0M-tdz7WatkqmbEtWsr0EMj8gOBtFVIHj3mOxKQVS8Ee0ZOc95Zox14zg8JWclNYxdx3fk7jN6tbgY8o070AmXe8RAjbMWE4aFmpgx02i3kqomH_UtpkxVMPSQ4o8Qs8vUBYreYPJHeihmpS_Te7fc0IRm1Wgozqi3IdQm9fvyjDyxymd8_nBekG_v3329_Fhdf_pwdfn2utIdiKVqoeEjDCPqsZm4GiYFqu9EO3GjLYotQq4Zt2wUY9MzoZRtuxYsV1wordoL8urkWx77c8W8yL3LGr1XAeOaJQwAvGeNGIu0O0l1ijkntPKQ3F6lowQmN-JylificiMuWS8L8dL28mHCOu3R_G36g7gI3pwEWP555zDJrAuigsWlQkWa6P434V8D7V1wWvlbPGKe45pCYShB5kYy-WXb-rZ06FsA0XxvfwE1FatJ</recordid><startdate>20161001</startdate><enddate>20161001</enddate><creator>Franco-Peláez, Juan Antonio</creator><creator>Cortés-García, Marcelino</creator><creator>Romero-Daza, Angélica María</creator><creator>Martín-Mariscal, María Luisa</creator><creator>García-Ropero, Álvaro</creator><creator>López-Castillo, Marta</creator><creator>Palfy, Julia Anna</creator><creator>Pello-Lázaro, Ana María</creator><creator>Taibo-Urquía, Mikel</creator><creator>Briongos-Figuero, Sem</creator><creator>Farré, Jerónimo</creator><general>Elsevier Ireland Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-5360-7066</orcidid></search><sort><creationdate>20161001</creationdate><title>Relationship between different doses of beta-blockers and prognosis in elderly patients with reduced ejection fraction</title><author>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</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c417t-31259189ec92b5a8ba1a6473b5dcfe7a1a6e5c05f09792607aaf3431f5a57aca3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adrenergic beta-Antagonists - administration & dosage</topic><topic>Adrenergic beta-Antagonists - adverse effects</topic><topic>Adrenergic beta-Antagonists - classification</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Beta-blocker</topic><topic>Cardiovascular</topic><topic>Disease Progression</topic><topic>Dose-Response Relationship, Drug</topic><topic>Elderly</topic><topic>Female</topic><topic>Heart failure</topic><topic>Heart Failure - diagnosis</topic><topic>Heart Failure - drug therapy</topic><topic>Heart Failure - mortality</topic><topic>Heart Failure - physiopathology</topic><topic>Hospitalization - statistics & numerical data</topic><topic>Humans</topic><topic>Left ventricular dysfunction</topic><topic>Male</topic><topic>Prognosis</topic><topic>Propensity Score</topic><topic>Proportional Hazards Models</topic><topic>Risk Assessment - methods</topic><topic>Spain - epidemiology</topic><topic>Stroke Volume - drug effects</topic><topic>Survival Analysis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Franco-Peláez, Juan Antonio</creatorcontrib><creatorcontrib>Cortés-García, Marcelino</creatorcontrib><creatorcontrib>Romero-Daza, Angélica María</creatorcontrib><creatorcontrib>Martín-Mariscal, María Luisa</creatorcontrib><creatorcontrib>García-Ropero, Álvaro</creatorcontrib><creatorcontrib>López-Castillo, Marta</creatorcontrib><creatorcontrib>Palfy, Julia Anna</creatorcontrib><creatorcontrib>Pello-Lázaro, Ana María</creatorcontrib><creatorcontrib>Taibo-Urquía, Mikel</creatorcontrib><creatorcontrib>Briongos-Figuero, Sem</creatorcontrib><creatorcontrib>Farré, Jerónimo</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>International journal of cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Franco-Peláez, Juan Antonio</au><au>Cortés-García, Marcelino</au><au>Romero-Daza, Angélica María</au><au>Martín-Mariscal, María Luisa</au><au>García-Ropero, Álvaro</au><au>López-Castillo, Marta</au><au>Palfy, Julia Anna</au><au>Pello-Lázaro, Ana María</au><au>Taibo-Urquía, Mikel</au><au>Briongos-Figuero, Sem</au><au>Farré, Jerónimo</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Relationship between different doses of beta-blockers and prognosis in elderly patients with reduced ejection fraction</atitle><jtitle>International journal of cardiology</jtitle><addtitle>Int J Cardiol</addtitle><date>2016-10-01</date><risdate>2016</risdate><volume>220</volume><spage>219</spage><epage>225</epage><pages>219-225</pages><issn>0167-5273</issn><eissn>1874-1754</eissn><notes>ObjectType-Article-2</notes><notes>SourceType-Scholarly Journals-1</notes><notes>ObjectType-Undefined-1</notes><notes>ObjectType-Feature-3</notes><notes>content type line 23</notes><abstract>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.</abstract><cop>Netherlands</cop><pub>Elsevier Ireland Ltd</pub><pmid>27389445</pmid><doi>10.1016/j.ijcard.2016.06.178</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0001-5360-7066</orcidid></addata></record> |
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| ispartof | International journal of cardiology, 2016-10, Vol.220, p.219-225 |
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| 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 |
| title | Relationship between different doses of beta-blockers and prognosis in elderly patients with reduced ejection fraction |
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