Comparison of the clinical outcome of different beta-blockers in heart failure patients: a retrospective nationwide cohort study

TY - JOUR

T1 - Comparison of the clinical outcome of different beta-blockers in heart failure patients

T2 - a retrospective nationwide cohort study

AU - Bølling, Rasmus

AU - Scheller, Nikolai Madrid

AU - Køber, Lars

AU - Poulsen, Henrik Enghusen

AU - Gislason, Gunnar H

AU - Torp-Pedersen, Christian

N1 - © 2014 The Authors. European Journal of Heart Failure © 2014 European Society of Cardiology.

PY - 2014/6

Y1 - 2014/6

N2 - AIM: To compare survival on different beta-blockers in heart failure.METHODS AND RESULTS: We identified all Danish patients ≥35 years of age who were hospitalized with a first admission for heart failure and who initiated treatment with a beta-blocker within 60 days of discharge. The study period was 1995-2011. The main outcome was all-cause mortality and all-cause hospitalization. Cox proportional hazard models were used to compare survival. The study included 58 634 patients of whom 30.121 (51.4%) died and 46.990 (80.1%) were hospitalized during follow-up. The mean follow-up time was 4.1 years. In an unadjusted model carvedilol was associated with a lower mortality [hazard ratio (HR) 0.737, 0.714-0.761] compared with metoprolol (reference) while bisoprolol was not associated with an increased mortality (HR 1.020, 0.973-1.069). In a model adjusted for possible confounders and stratified according to beta-blocker dosages, patients that received high-dose carvedilol (≥50 mg daily) had a lower all-cause mortality risk (HR 0.873, 0.789-0.966) than patients receiving high-dose (≥200 mg daily) metoprolol (reference). High-dose bisoprolol (≥10 mg daily) was associated with a greater risk of death (HR 1.125, 1.004-1.261). High-dose carvedilol was associated with significantly lower all-cause hospitalization risk (HR 0.842, 0.774-0.915) than high-dose metoprolol (reference), while high-dose bisoprolol had insignificantly lower risk than high-dose metoprolol (HR 0.948, 0.850-1.057).CONCLUSIONS: Heart failure patients receiving high-dose carvedilol (≥50 mg daily) showed significantly lower all-cause mortality risk and hospitalization risk, compared with other beta-blockers.

AB - AIM: To compare survival on different beta-blockers in heart failure.METHODS AND RESULTS: We identified all Danish patients ≥35 years of age who were hospitalized with a first admission for heart failure and who initiated treatment with a beta-blocker within 60 days of discharge. The study period was 1995-2011. The main outcome was all-cause mortality and all-cause hospitalization. Cox proportional hazard models were used to compare survival. The study included 58 634 patients of whom 30.121 (51.4%) died and 46.990 (80.1%) were hospitalized during follow-up. The mean follow-up time was 4.1 years. In an unadjusted model carvedilol was associated with a lower mortality [hazard ratio (HR) 0.737, 0.714-0.761] compared with metoprolol (reference) while bisoprolol was not associated with an increased mortality (HR 1.020, 0.973-1.069). In a model adjusted for possible confounders and stratified according to beta-blocker dosages, patients that received high-dose carvedilol (≥50 mg daily) had a lower all-cause mortality risk (HR 0.873, 0.789-0.966) than patients receiving high-dose (≥200 mg daily) metoprolol (reference). High-dose bisoprolol (≥10 mg daily) was associated with a greater risk of death (HR 1.125, 1.004-1.261). High-dose carvedilol was associated with significantly lower all-cause hospitalization risk (HR 0.842, 0.774-0.915) than high-dose metoprolol (reference), while high-dose bisoprolol had insignificantly lower risk than high-dose metoprolol (HR 0.948, 0.850-1.057).CONCLUSIONS: Heart failure patients receiving high-dose carvedilol (≥50 mg daily) showed significantly lower all-cause mortality risk and hospitalization risk, compared with other beta-blockers.

KW - Adrenergic beta-Antagonists

KW - Aged

KW - Cohort Studies

KW - Denmark

KW - Female

KW - Follow-Up Studies

KW - Heart Failure

KW - Hospitalization

KW - Humans

KW - Male

KW - Middle Aged

KW - Proportional Hazards Models

KW - Retrospective Studies

KW - Survival Analysis

KW - Treatment Outcome

U2 - 10.1002/ejhf.81

DO - 10.1002/ejhf.81

M3 - Journal article

C2 - 24706485

SN - 1567-4215

VL - 16

SP - 678

EP - 684

JO - European Journal of Heart Failure, Supplement

JF - European Journal of Heart Failure, Supplement

IS - 6

ER -