Long-term use of beta blockers is associated with reduced mortality in patients with heart failure
Long-term use of beta blockers is significantly associated with a lower risk of death in patients with heart failure, according to a recent study by Nancy M. Allen LaPointe, Pharm.D., and her associates at Duke University Medical Center. They found a 27 percent lower risk of death for patients with heart failure and coronary artery disease using beta blockers persistently over the first 2 years after a cardiac catheterization when compared with patients who did not use beta blockers in this same time period. They found no significant difference in death between persistent use of evidence-based beta blockers for chronic heart failure and other beta blockers in this group of persistent users. In addition, they found no significant difference in death between heart failure patients who received angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) persistently over the first 2 years after a cardiac catheterization compared with those who did not use ACEIs or ARBs in this same time period.
The researchers used data from the Duke Databank for Cardiovascular Disease (DDCD), complemented by searches of the National Death Index, to study the use of beta blockers and ACEIs/ARBs in all patients who had undergone a cardiac procedure at Duke and were found to have significant coronary artery disease and a left ventricular ejection fraction of less than 40 percent (fraction of blood pumped out of the heart's ventricle). Patients with significant coronary artery disease—those with at least one diseased coronary artery, those who had undergone angioplasty, and/or those who had undergone coronary artery bypass—were asked to participate in a clinical followup program that is part of the DDCD. Patients (or their families) were contacted by mail or telephone 6 months after their first entry into the database and approximately every year thereafter for the followup. Of the 3,187 patients identified for beta blocker analysis, 42 percent had persistent use of any beta blocker for at least 2 years after the catheterization. Among those surviving the 2 years, the risk of death was significantly lower in those who had persistent beta blocker use than those with no beta blocker use. Of the 3,166 patients identified for ACEI/ARB analysis, 42.5 percent were considered persistent users during the 2 years after catheterization.
These findings underscore the need to continually encourage and monitor beta blocker use as a key part of the management of chronic heart failure, note the researchers. However, they caution that because the data were collected at a single medical center, the findings may not be generalizable to other health care systems. The study was funded in part by the Agency for Healthcare Research and Quality (HS10548).
More details are in "Association between mortality and persistent use of beta blockers and angiotensin-converting enzyme inhibitors in patients with left ventricular systolic dysfunction and coronary artery disease," by Dr. Allen LaPointe, Yi Zhou, M.S., Judith A. Stafford, M.S., and others, in the 2009 American Journal of Cardiology 103, pp. 1518-1524, 2009.
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