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Background

Association between Use of Beta-Blockers and Mortality in Patients with Heart Failure and Preserved Ejection Fraction a Prospective Propensity Score- Matched Cohort Study Lars H Lund , Lina Benson, Ulf Dahlström, Magnus Edner, Leif Friberg on behalf of the Swedish Heart Failure Registry

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Background

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  1. Association between Use of Beta-Blockers and Mortality in Patients with Heart Failure and Preserved Ejection Fraction a ProspectivePropensity Score-MatchedCohortStudy Lars H Lund, Lina Benson, Ulf Dahlström, Magnus Edner, Leif Friberg on behalfof the Swedish HeartFailureRegistry Conflictsofinterest: Research funding, speaker’sfees, consultancies: AstraZeneca Novartis Boston Scientific

  2. Background • HeartFailurewithPreservedEjectionFraction – HFpEF • As common and possibly as lethalas • HF withreduced EF - HFrEF • Catecholamineactivation • β-blockers • reducebloodpressure, LVH, diastolicdysfunction • Butfewclinical studies and conflictingoutcomes

  3. Background Hypothesis: β-blockers areassociatedwith Primaryoutcome: Reducedall-cause mortality Secondaryoutcome: Reducedcombined all-cause mortality or HF hospitalization - in a broad un-selectedHFpEFpopulation

  4. Methods • The Swedish HeartFailureRegistry • Inclusioncriteria: clinician-judged HF • Exlusioncriteria: opt-out

  5. Methods • Swedish HF Registry: • Demographics • Clinical history • Physicalexam, lab, x-ray, echo • Medications • Swedish Patient Registry: • Comorbidity • Statistics Sweden: • Education • Income • Family situation 88,663 Registrations 2000 – 2013 67 of75 hospitals validity / generalizability 52relevant co-variates  reliability 10,905EF unknown 77,757 45,397EF < 40% 32,360 EF ≥ 40% 13,277Repeatregistrations Or index before 2005 / after 2012

  6. Methods BBNo: 3,297 19,083 EF ≥ 40% BByes: 15,786 Propensityscore matching2:1 24,747EF < 40% ”positive control” BBNo: 2,748 8,244Matched population BBYes: 5,496

  7. Results Baselinecharacteristics: Overall cohort: Treated patients: younger, lower EF, higher NT-proBNP, more RAS-antagonist use

  8. Results Baselinecharacteristics: Overall cohort: Treated patients: younger, lower EF, higher NT-proBNP, more RAS-antagonist use Matchedcohort: smalldifferences

  9. Results Propensity score for β-blocker Propensity scores Similar Different

  10. Results β-blockers associatedwithreducedmortality in HFpEF 1-year survival 84% 80% 79% 78% NNT=100 5-year survival 51% 45% 42% 41% NNT=33 Un-adjusted HR: 0.73, p < 0.001 Matched HR: 0.92, p = 0.021

  11. Results β-blockers associatedwithreducedmortality in HFpEF 1-year survival 84% 80% 79% 78% NNT=100 5-year survival 51% 45% 42% 41% NNT=33 Un-adjusted HR: 0.73, p < 0.001 Matched HR: 0.92, p = 0.021 But β-blockers not associatedwithreducedcombinedmortality / HF hospitalization in HFpEF

  12. Results HFrEF positive control: BB associatedwithreducedmortality in HFREF: HR 0.90 in HFREF vs. 0.92 in HFPEF MatchedHR: 0.90, p=0.008

  13. Conclusion • Summary: • β-blockers wereassociatedwithreduced all-cause mortality in HFpEF: • HR 0.92 - 8% reduction in all-cause mortality • But not combined all-cause mortality / HF hospitalization • HFrEF positive control: • Similarreductionmortality lends support to HFPEF findings • Implication: • Adequatelypoweredrandomized trial needed in HFpEF • FutureDirection: • RegistryRandomized Trial

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