Abstract
Background
Beta-blockers improve clinical outcomes in patients with heart failure with reduced
ejection fraction (HFrEF). Less is known about their role in older nursing home residents
with HFrEF.
Methods
From the combined OPTIMIZE-HF and Alabama Heart Failure Project data sets, we assembled
a propensity score-matched balanced cohort of 6494 hospitalized patients ≥65 years
with HFrEF (ejection fraction ≤40%). In our primary approach, hazard ratios (HRs)
and 95% confidence intervals (CI)s for outcomes associated with discharge prescriptions
for beta- blockers were estimated, examining for heterogeneity by admission from nursing
homes. In our sensitivity approach, we examined these associations in a separately
assembled propensity score-matched cohort of 122 patients admitted from nursing homes.
Results
In the matched primary cohort of 6494 patients, HRs (95% CIs) for 12-month all-cause
mortality and heart failure readmission were 0.80 (0.74-0.87) and 0.94 (0.86-1.02),
respectively. Respective HRs (95% CIs) in the nursing home and non-nursing home subgroups
were 0.77 (0.51-1.16) and 0.81 (0.74-0.87) for all-cause mortality (interaction P: 0.653) and 1.06 (0.53-2.12) and 0.89 (0.82-0.96) for heart failure readmission (interaction
P: 0.753). In the matched sensitivity cohort of 122 patients admitted from nursing
homes, HRs (95% CIs) for 12-month all-cause mortality and heart failure readmission
were 0.86 (0.55-1.35) and 1.07 (0.52-2.22), respectively. Similar associations were
observed for 30-day outcomes.
Conclusions
Beta-blocker use was associated with a lower risk of all-cause mortality but not of
heart failure readmission in older patients with HFrEF, which were similar for patients
admitted and not admitted from nursing homes.
Keywords
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Article Info
Publication History
Published online: November 29, 2021
Footnotes
Funding: AA was in part supported by the National Institutes of Health through grants ( R01-HL085561 , R01-HL085561-S and R01-HL097047 ) from the National Heart, Lung, and Blood Institute , and by the Department of Veterans Affairs Office of Research and Development grant through a grant ( I01HX002422 ) from the Health Services Research & Development Service .
Conflicts of Interest: GCF reports consulting with Abbott, Amgen, Astra Zeneca, Bayer, CHF Solutions, Cytokinetics, Edwards, Janssen, Medtronic, Merck, and Novartis and was the principal investigator of OPTIMIZE-HF. GlaxoSmithKline sponsored OPTIMIZE-HF but played no role in the design, conduct, analyses, or interpretation of the current study. EB, PHL, RE, CA, HMS, VB, CYJ, PD, CF, RMA, AA report none. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Department of Veterans Affairs.
Authorship: All authors had access to the data and a role in writing this manuscript.
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