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Association between mortality and persistent use of beta blockers and angiotensin-converting enzyme inhibitors in patients with left ventricular systolic dysfunction and coronary artery disease.

Publication ,  Journal Article
Allen LaPointe, NM; Zhou, Y; Stafford, JA; Hernandez, AF; Kramer, JM; Anstrom, KJ
Published in: Am J Cardiol
June 1, 2009

Beta blockers and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEIs/ARBs) are evidence-based medications for chronic heart failure, but little is known about the persistent use and clinical effectiveness of these medications. We evaluated the longer-term use of beta blockers and ACEIs/ARBs in patients with left ventricular systolic dysfunction and coronary artery disease. Patients with an ejection fraction <40% and coronary artery disease who had a cardiac catheterization from April 1994 through December 2005 were identified. Long-term patterns of beta-blocker and ACEI/ARB use were categorized as persistent, new, previous, or no use based on information from routine follow-up surveys. Characteristics among medication-use groups were explored, and survival associated with persistent use was determined. Of 3,187 patients identified for the beta-blocker analysis, 1,339 (42.0%) had persistent use. Conditional on surviving for > or = 2 follow-up surveys, the adjusted risk of death was statistically significantly lower with persistent use versus no use (hazard ratio [HR] 0.73, 95% confidence interval [CI] 0.65 to 0.82) and new use versus no use (HR 0.81, 95% CI 0.68 to 0.97). Adjusted risk of death was not statistically significantly different between persistent or new use of an evidence-based beta blocker and persistent use of a nonevidence-based beta blocker (HR 0.96, 95% CI 0.78 to 1.17). Of 3,166 patients identified for the ACEI/ARB analysis, 1,347 (42.5%) had persistent use. There was no statistically significant association between adjusted mortality and persistent use (HR 0.93, 95% CI 0.81 to 1.05), new use (HR 0.86, 95% CI 0.71 to 1.03), or previous use (HR 0.88, 95% CI 0.73 to 1.07) compared with no ACEI/ARB use. In conclusion, persistent and new use of beta blockers was associated with survival, but evidence-based beta blockers did not appear superior to nonevidence-based beta blockers. We were unable to demonstrate a statistically significant association between persistent ACEI/ARB use and survival.

Duke Scholars

Published In

Am J Cardiol

DOI

EISSN

1879-1913

Publication Date

June 1, 2009

Volume

103

Issue

11

Start / End Page

1518 / 1524

Location

United States

Related Subject Headings

  • Ventricular Dysfunction, Left
  • Survival Analysis
  • Propanolamines
  • Middle Aged
  • Metoprolol
  • Male
  • Humans
  • Female
  • Coronary Artery Disease
  • Comorbidity
 

Citation

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Allen LaPointe, N. M., Zhou, Y., Stafford, J. A., Hernandez, A. F., Kramer, J. M., & Anstrom, K. J. (2009). Association between mortality and persistent use of beta blockers and angiotensin-converting enzyme inhibitors in patients with left ventricular systolic dysfunction and coronary artery disease. Am J Cardiol, 103(11), 1518–1524. https://doi.org/10.1016/j.amjcard.2009.01.363
Allen LaPointe, Nancy M., Yi Zhou, Judith A. Stafford, Adrian F. Hernandez, Judith M. Kramer, and Kevin J. Anstrom. “Association between mortality and persistent use of beta blockers and angiotensin-converting enzyme inhibitors in patients with left ventricular systolic dysfunction and coronary artery disease.Am J Cardiol 103, no. 11 (June 1, 2009): 1518–24. https://doi.org/10.1016/j.amjcard.2009.01.363.
Allen LaPointe, Nancy M., et al. “Association between mortality and persistent use of beta blockers and angiotensin-converting enzyme inhibitors in patients with left ventricular systolic dysfunction and coronary artery disease.Am J Cardiol, vol. 103, no. 11, June 2009, pp. 1518–24. Pubmed, doi:10.1016/j.amjcard.2009.01.363.
Journal cover image

Published In

Am J Cardiol

DOI

EISSN

1879-1913

Publication Date

June 1, 2009

Volume

103

Issue

11

Start / End Page

1518 / 1524

Location

United States

Related Subject Headings

  • Ventricular Dysfunction, Left
  • Survival Analysis
  • Propanolamines
  • Middle Aged
  • Metoprolol
  • Male
  • Humans
  • Female
  • Coronary Artery Disease
  • Comorbidity