Effectiveness of β-blocker therapy in daily practice patients with advanced chronic heart failure; is there an effect-modification by age?

Abstract

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. © 2006 The Authors.