Skip to main content

Comparative effectiveness of beta-blockers in elderly patients with heart failure.

Publication ,  Journal Article
Kramer, JM; Curtis, LH; Dupree, CS; Pelter, D; Hernandez, A; Massing, M; Anstrom, KJ
Published in: Arch Intern Med
December 8, 2008

BACKGROUND: Whether beta-blockers (BBs) other than carvedilol, metoprolol succinate, and bisoprolol fumarate (evidence-based beta-blockers [EBBBs]) improve survival in patients with heart failure (HF) is unknown. We compared the effectiveness of EBBBs vs non-EBBBs on survival. METHODS: Our study population included North Carolina residents at least 65 years old who were eligible for Medicare and Medicaid with pharmacy benefits and had had at least 1 hospitalization for HF during the period 2001 through 2004. Primary outcome was survival from 30 days to 1 year. Secondary outcomes included number and days of rehospitalizations for HF and number of outpatient visits. Cohorts were defined by BB class (EBBBs, non-EBBBs, or no BBs) in first 30 days after discharge from index hospitalization for HF. Outcomes were analyzed using inverse probability-weighted (IPW) estimators with propensity score adjustment. RESULTS: Of 11,959 patients, 40% were nonwhite, 79% were female, and 26% were at least 85 years old. Fifty-nine percent received no BB, 23% received EBBBs, and 18% received non-EBBBs. One-year adjusted mortality rates were 28.3% (no BBs), 22.8% (non-EBBBs), and 24.2% (EBBBs). The IPW-adjusted comparisons of 1-year mortality outcomes for either non-EBBBs or EBBBs compared with no BBs were statistically significant (P = .002 for both), but there was no statistical difference between the 2 BB groups (P = .43). The IPW-adjusted mean numbers of rehospitalizations for HF were 0.33 (no BBs), 0.29 (non-EBBBs), and 0.41 (EBBBs), with statistically more rehospitalizations in patients receiving EBBBs compared with no BBs (P = .002) and with non-EBBBs (P < .001). CONCLUSION: In this elderly population, the comparative effectiveness of EBBBs vs non-EBBBs was similar for 1-year survival, whereas the rehospitalization rate was higher for patients receiving EBBBs.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

Arch Intern Med

DOI

EISSN

1538-3679

Publication Date

December 8, 2008

Volume

168

Issue

22

Start / End Page

2422 / 2428

Location

United States

Related Subject Headings

  • Middle Aged
  • Male
  • Humans
  • Heart Failure
  • General & Internal Medicine
  • Female
  • Evidence-Based Medicine
  • Aged, 80 and over
  • Aged
  • Adrenergic beta-Antagonists
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Kramer, J. M., Curtis, L. H., Dupree, C. S., Pelter, D., Hernandez, A., Massing, M., & Anstrom, K. J. (2008). Comparative effectiveness of beta-blockers in elderly patients with heart failure. Arch Intern Med, 168(22), 2422–2428. https://doi.org/10.1001/archinternmed.2008.511
Kramer, Judith M., Lesley H. Curtis, Carla S. Dupree, David Pelter, Adrian Hernandez, Mark Massing, and Kevin J. Anstrom. “Comparative effectiveness of beta-blockers in elderly patients with heart failure.Arch Intern Med 168, no. 22 (December 8, 2008): 2422–28. https://doi.org/10.1001/archinternmed.2008.511.
Kramer JM, Curtis LH, Dupree CS, Pelter D, Hernandez A, Massing M, et al. Comparative effectiveness of beta-blockers in elderly patients with heart failure. Arch Intern Med. 2008 Dec 8;168(22):2422–8.
Kramer, Judith M., et al. “Comparative effectiveness of beta-blockers in elderly patients with heart failure.Arch Intern Med, vol. 168, no. 22, Dec. 2008, pp. 2422–28. Pubmed, doi:10.1001/archinternmed.2008.511.
Kramer JM, Curtis LH, Dupree CS, Pelter D, Hernandez A, Massing M, Anstrom KJ. Comparative effectiveness of beta-blockers in elderly patients with heart failure. Arch Intern Med. 2008 Dec 8;168(22):2422–2428.

Published In

Arch Intern Med

DOI

EISSN

1538-3679

Publication Date

December 8, 2008

Volume

168

Issue

22

Start / End Page

2422 / 2428

Location

United States

Related Subject Headings

  • Middle Aged
  • Male
  • Humans
  • Heart Failure
  • General & Internal Medicine
  • Female
  • Evidence-Based Medicine
  • Aged, 80 and over
  • Aged
  • Adrenergic beta-Antagonists