Association of β-blocker use with mortality among patients with congestive heart failure in the Cardiovascular Health Study (CHS)

Chan, Jeannie D.; Rea, Thomas D.; Smith, Nicholas L.; Siscovick, David; Heckbert, Susan R.; Lumley, Thomas; Chaves, Paulo; Furberg, Curt D.; Kuller, Lewis; Psaty, Bruce M.

doi:10.1016/j.ahj.2004.12.022

« Previous Next »American Heart Journal
Volume 150, Issue 3 , Pages 464-470, September 2005

Association of β-blocker use with mortality among patients with congestive heart failure in the Cardiovascular Health Study (CHS)

Jeannie D. Chan, PharmD, MPH
- Reprint requests: Jeannie D. Chan, PharmD, MPH, Department of Pharmacy, Harborview Medical Center, Room GEH-74, Box 359885, 325 Ninth Avenue, Seattle, WA 98104.
- Department of Pharmacy, University of Washington, Seattle, Wash
- Department of Epidemiology, University of Washington, Seattle, Wash
Thomas D. Rea, MD, MPH
- Department of Medicine, University of Washington, Seattle, Wash
Nicholas L. Smith, PhD
- Department of Epidemiology, University of Washington, Seattle, Wash
David Siscovick, MD, MPH
- Department of Epidemiology, University of Washington, Seattle, Wash
- Department of Medicine, University of Washington, Seattle, Wash
Susan R. Heckbert, MD, PhD
- Department of Pharmacy, University of Washington, Seattle, Wash
- Department of Epidemiology, University of Washington, Seattle, Wash
Thomas Lumley, PhD
- Department of Biostatistics, University of Washington, Seattle, Wash
Paulo Chaves, MD, PhD
- Department of Epidemiology, Johns Hopkins University, Baltimore, Md
Curt D. Furberg, MD, PhD
- Department of Public Health Sciences, Wake Forest University, Winston-Salem, NC
Lewis Kuller, MD, DrPH
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pa
Bruce M. Psaty, MD, PhD
- Department of Epidemiology, University of Washington, Seattle, Wash
- Department of Medicine, University of Washington, Seattle, Wash
- Department of Health Services, University of Washington, Seattle, Wash

Received 6 August 2004; accepted 26 December 2004.

Background

In clinical trials, β-blocker therapy reduces all-cause mortality among people with congestive heart failure (CHF) characterized by depressed systolic function, but few trials included large numbers of elderly participants. This study assessed the association between β-blocker therapy and mortality among community-dwelling older adults with CHF.

Methods

The Cardiovascular Health Study (CHS) is a longitudinal, population-based study of adults aged ≥65 years. Recruitment began in 1989 with follow-up extending through June 2000 or death. Cox proportional hazard regression models were used to assess the association between β-blocker therapy and all-cause mortality among 950 participants who developed new-onset CHF.

Results

β-Blocker users (n = 157) were more likely than nonusers (n = 793) to have treated hypertension, clinical coronary artery disease, and valvular disease at the time of CHF diagnosis. Death occurred in 67 users and 446 nonusers during a median follow-up of 2.3 years. Compared with nonuse, use of β-blockers was associated with a multivariable adjusted hazard ratio (HR) of 0.74 (95% CI 0.56-0.98) for all-cause mortality. Among the 520 participants who had left ventricular ejection fraction assessed within 90 days after CHF diagnosis, the risk for all cause mortality associated with β-blocker use did not differ significantly between those with ejection fraction of <40% and those with ejection fraction of ≥40% (HR 0.56, 95% CI 0.27-1.13; HR 0.82, 95% CI 0.56-1.22, respectively; interaction P = .34).

Conclusions

This observational study suggests that β-blocker treatment is associated with a reduced risk of all-cause mortality among community-dwelling older adults with CHF.