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Clinical effectiveness of beta-blockers in heart failure: findings from the OPTIMIZE-HF (Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure) Registry.

Publication ,  Journal Article
Hernandez, AF; Hammill, BG; O'Connor, CM; Schulman, KA; Curtis, LH; Fonarow, GC
Published in: J Am Coll Cardiol
January 13, 2009

OBJECTIVES: We sought to examine associations between initiation of beta-blocker therapy and outcomes among elderly patients hospitalized for heart failure. BACKGROUND: Beta-blockers are guideline-recommended therapy for heart failure, but their clinical effectiveness is not well understood, especially in elderly patients. METHODS: We merged Medicare claims data with OPTIMIZE-HF (Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure) records to examine long-term outcomes of eligible patients newly initiated on beta-blocker therapy. We used inverse probability-weighted Cox proportional hazards models to determine the relationships among treatment and mortality, rehospitalization, and a combined mortality-rehospitalization end point. RESULTS: Observed 1-year mortality was 33%, and all-cause rehospitalization was 64%. Among 7,154 patients hospitalized with heart failure and eligible for beta-blockers, 3,421 (49%) were newly initiated on beta-blocker therapy. Among patients with left ventricular systolic dysfunction (LVSD) (n = 3,001), beta-blockers were associated with adjusted hazard ratios of 0.77 (95% confidence interval [CI]: 0.68 to 0.87) for mortality, 0.89 (95% CI: 0.80 to 0.99) for rehospitalization, and 0.87 (95% CI: 0.79 to 0.96) for mortality-rehospitalization. Among patients with preserved systolic function (n = 4,153), beta-blockers were associated with adjusted hazard ratios of 0.94 (95% CI: 0.84 to 1.07) for mortality, 0.98 (95% CI: 0.90 to 1.06) for rehospitalization, and 0.98 (95% CI: 0.91 to 1.06) for mortality-rehospitalization. CONCLUSIONS: In elderly patients hospitalized with heart failure and LVSD, incident beta-blocker use was clinically effective and independently associated with lower risks of death and rehospitalization. Patients with preserved systolic function had poor outcomes, and beta-blockers did not significantly influence the mortality and rehospitalization risks for these patients.

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Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

January 13, 2009

Volume

53

Issue

2

Start / End Page

184 / 192

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Risk Factors
  • Registries
  • Patient Readmission
  • Male
  • Humans
  • Heart Failure
  • Female
  • Cardiovascular System & Hematology
  • Aged, 80 and over
 

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Hernandez, A. F., Hammill, B. G., O’Connor, C. M., Schulman, K. A., Curtis, L. H., & Fonarow, G. C. (2009). Clinical effectiveness of beta-blockers in heart failure: findings from the OPTIMIZE-HF (Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure) Registry. J Am Coll Cardiol, 53(2), 184–192. https://doi.org/10.1016/j.jacc.2008.09.031
Hernandez, Adrian F., Bradley G. Hammill, Christopher M. O’Connor, Kevin A. Schulman, Lesley H. Curtis, and Gregg C. Fonarow. “Clinical effectiveness of beta-blockers in heart failure: findings from the OPTIMIZE-HF (Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure) Registry.J Am Coll Cardiol 53, no. 2 (January 13, 2009): 184–92. https://doi.org/10.1016/j.jacc.2008.09.031.
Hernandez, Adrian F., et al. “Clinical effectiveness of beta-blockers in heart failure: findings from the OPTIMIZE-HF (Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure) Registry.J Am Coll Cardiol, vol. 53, no. 2, Jan. 2009, pp. 184–92. Pubmed, doi:10.1016/j.jacc.2008.09.031.
Journal cover image

Published In

J Am Coll Cardiol

DOI

EISSN

1558-3597

Publication Date

January 13, 2009

Volume

53

Issue

2

Start / End Page

184 / 192

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Risk Factors
  • Registries
  • Patient Readmission
  • Male
  • Humans
  • Heart Failure
  • Female
  • Cardiovascular System & Hematology
  • Aged, 80 and over