Effectiveness of ?-blocker therapy in daily practice patients with advanced chronic heart failure; is there an effect-modification by age?
| Autor: | Ger Cleuren, Daniela Dobre, Flora M. Haaijer-Ruskamp, Carolien Lucas, Dirk J. van Veldhuisen, Mike J. L. DeJongste, Adelita V. Ranchor |
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| Přispěvatelé: | Science in Healthy Ageing & healthcaRE (SHARE), Health Psychology Research (HPR), Cardiovascular Centre (CVC) |
| Rok vydání: | 2007 |
| Předmět: |
Male
Relative risk reduction medicine.medical_specialty Adrenergic beta-Antagonists Therapeutics VENTRICULAR EJECTION FRACTION beta-blockers MORBIDITY Internal medicine advanced chronic heart failure medicine Humans Pharmacology (medical) Practice Patterns Physicians' daily practice Medical prescription ELDERLY-PATIENTS Survival rate Aged Netherlands Heart Failure Pharmacology CARVEDILOL HOSPITAL DISCHARGE Ejection fraction business.industry MORTALITY Hazard ratio Age Factors medicine.disease DYSFUNCTION Confidence interval Surgery Survival Rate Heart failure Cohort EXPERIENCE Female business MERIT-HF CLINICAL-TRIALS |
| Zdroj: | British Journal of Clinical Pharmacology, 63(3), 356-364. Wiley |
| ISSN: | 1365-2125 0306-5251 |
| DOI: | 10.1111/j.1365-2125.2006.02769.x |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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