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Effectiveness of β‐blocker therapy in daily practice patients with advanced chronic heart failure; is there an effect‐modification by age?
Author(s) -
Dobre Daniela,
DeJongste Mike J. L.,
Lucas Carolien,
Cleuren Ger,
Van Veldhuisen Dirk J.,
Ranchor Adelita V.,
HaaijerRuskamp Flora
Publication year - 2007
Publication title -
british journal of clinical pharmacology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.216
H-Index - 146
eISSN - 1365-2125
pISSN - 0306-5251
DOI - 10.1111/j.1365-2125.2006.02769.x
Subject(s) - heart failure , medicine , intensive care medicine , physical therapy , cardiology
Aims The effects of β‐blockers in daily practice patients with advanced chronic heart failure (CHF) and a broad range of ejection fraction (EF) are not well established. We aimed to assess, first , the association between β‐blocker prescription at discharge and mortality in a cohort of patients with advanced CHF, and second , whether this association is modified by the age of the patient. Methods Patients diagnosed with advanced CHF ( n = 625) were prospectively followed after discharge from the Cardiology Department . The mean age was 76 years, 53% male, mean EF 42 ± 16%. Overall, 308 (49%) patients had a β‐blocker prescribed at discharge, 140 (22%) low‐dose and 168 (27%) high‐dose therapy. We used multivariate Cox analysis to assess the association between β‐blocker use at discharge and mortality. Results After a mean follow‐up of 22 months, 117 (27%) patients died. Prescription of a β‐blocker was associated with a 45% relative risk reduction (hazard ratio 0.55, 95% confidence interval 0.39, 0.78). The relative risk reduction was similar with low and high doses of β‐blockers (42% and 49%). However, the relative risk reduction was higher in younger than in older patients ( P = 0.006). In patients ≤75 years old prescription of a β‐blocker was associated with 71% risk reduction, whereas in patients >75 years old it was associated with 21% risk reduction. Conclusions In this daily practice cohort of patients with advanced CHF, prescription of a β‐blocker was associated with significant mortality reduction. However, the beneficial effects of β‐blockers appear to be greater in younger patients.