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CLINICAL RESEARCH: HEART FAILURE

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

Adrian F. Hernandez, MD, MHS^_*,,_*, Bradley G. Hammill, MS^_*, Christopher M. O'Connor, MD, FACC^_*,, Kevin A. Schulman, MD^_*,, Lesley H. Curtis, PhD^_*, and Gregg C. Fonarow, MD, FACC

^_* Duke Clinical Research Institute, Durham, North Carolina
Department of Medicine, Duke University School of Medicine, Durham, North Carolina
Ahmanson-UCLA Cardiomyopathy Center, Department of Medicine, UCLA Medical Center, Los Angeles, California

Manuscript received April 25, 2008; revised manuscript received August 25, 2008, accepted September 22, 2008.

^_* Reprint requests and correspondence: Dr. Adrian F. Hernandez, Duke Clinical Research Institute, P.O. Box 17969, Durham, North Carolina 27715 (Email: adrian.hernandez{at}duke.edu).

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.

Key Words: adrenergic beta-antagonists • heart failure • mortality patient readmission

Abbreviations and Acronyms   ACE = angiotensin-converting enzyme   ARB = angiotensin receptor blocker   CI = confidence interval   LVEF = left ventricular ejection fraction   LVSD = left ventricular systolic dysfunction

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