Abstract
Introduction
Beta-blockers (BB) and renin–angiotensin system inhibitors (RASi) are foundational
for the treatment of heart failure with reduced ejection fraction (HFrEF). However,
given the increased risk of side effects in older patients, uncertainty remains as
to whether, on net, older patients benefit as much as the younger patients studied
in trials.
Methods and Results
Using the Get With The Guidelines–Heart Failure registry linked with Medicare data,
overlap propensity weighted Cox proportional hazard models were used to examine the
association between BB and RASi use at hospital discharge and 30-day and 1-year outcomes
among patients with HFrEF. Among the 48,711 patients (aged ≥65 years) hospitalized
with HFrEF, there were significant associations between BB and/or RASi use at discharge
and lower rates of 30-day and 1-year mortality, including those over age 85 (30-day
hazard ratio 0.56, 95% confidence interval 0.45–0.70; 1-year hazard ratio 0.69, 95%
confidence interval 0.61–0.78). In addition, the magnitude of benefit associated with
BB and/or RASi use after discharge did not decrease with advancing age. Even among
the oldest patients, those over age 85, with hypotension, renal insufficiency or frailty,
BB and/or RASi use at discharge was still associated with lower 1-year mortality or
readmission.
Conclusions
Among older patients hospitalized with HFrEF, BB and/or RASi use at discharge is associated
with lower rates of 30-day and 1-year mortality across all age groups and the magnitude
of this benefit does not seem to decrease with advancing age. These data suggest that,
absent a clinical contraindication, BB and RASi should be considered in all patients
hospitalized with HFrEF before or at hospital discharge, regardless of age.
Graphical abstract
Graphical Abstract
Key Words
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Article info
Publication history
Published online: December 11, 2022
Accepted:
November 4,
2022
Received in revised form:
November 3,
2022
Received:
May 31,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Elsevier Inc. All rights reserved.
