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CLINICAL RESEARCH: HEART FAILURE

Beta-blockers and angiotensin-converting enzyme inhibitors/receptor blockers prescriptions after hospital discharge for heart failure are associated with decreased mortality in Alberta, Canada

David Johnson, MD^*, Yan Jin, MA, Hude Quan, MD, PhD and Bibiana Cujec, MD^,*

^* Division of Critical Care Medicine, University of Alberta, Alberta, Canada
Research and Evidence, Alberta Health and Wellness, Alberta, Canada
Department of Community Health Sciences, University of Calgary, Calgary, Canada
Department of Medicine, University of Alberta, Edmonton, Alberta, Canada

Manuscript received January 8, 2003; revised manuscript received June 18, 2003, accepted June 25, 2003.

^* Reprint requests and correspondence: Dr. Bibiana Cujec, Division of Cardiology, University of Alberta, 2C2.39 WMC, Edmonton, Alberta, Canada T6G 2B7.
Bibiana.Cujec{at}ualberta.ca

OBJECTIVES: We sought to evaluate the common utilization of beta-blockers and angiotensin-converting enzyme (ACE) inhibitors or receptor blockers (RBs) in congestive heart failure (CHF).

BACKGROUND: We assessed the association between prescriptions of beta-blockers and ACE inhibitors or RBs within three months after hospitalization and mortality for newly diagnosed CHF in Alberta, Canada seniors (age 65 years and older).

METHODS: Administrative hospital discharge abstracts and drug data during October 1, 1994, to December 31, 1999, were analyzed.

RESULTS: There were 11,854 hospitalizations for newly diagnosed CHF. The use of beta-blockers within three months after hospitalization increased from 7.3% in 1994–1995 to 20.9% in 1999–2000. The use of ACE inhibitor or RBs within three months after hospitalization increased from 31.0% in 1994–1995 to 44.3% in 1999–2000. Adjusted one-year mortality was lower in seniors with prescriptions for beta-blockers (18.2%; 95% confidence interval [CI] 14.2 to 22.2), ACE inhibitors/RBs (22.3%; 95% CI 20.9 to 23.7), or both (16.6%; 95% CI 13.3 to 20.0), compared with those with no prescriptions (29.9%; 95% CI 28.8 to 31.0). Absolute adjusted risk reduction comparing no prescription with prescription of both beta-blockers or ACE inhibitors/RBs was 13.3% for a relative adjusted risk reduction of 44%.

CONCLUSIONS: This study of incident CHF hospitalizations among seniors demonstrates an association between decreased mortality and the use of beta-blockers, ACE inhibitors/RBs, or combination of both. The effectiveness of beta-blockers and ACE inhibitors/RBs for CHF should be more broadly tested in clinical trials that recruit older patients and those with diastolic dysfunction.

Abbreviations and Acronyms   ACE = angiotensin-converting enzyme   CHF = congestive heart failure   CPX = Canadian Classification of Procedures   ICD-9-CM = International Classification of Disease- Ninth Revision-Clinical Modification   RB = receptor blocker

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