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J Am Coll Cardiol. 2014 Jul 22;64(3):247-52. doi: 10.1016/j.jacc.2014.04.042.

β-blocker therapy and cardiac events among patients with newly diagnosed coronary heart disease.

Author information

1
Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark.
2
Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California.
3
Division of Research, Kaiser Permanente, Oakland, California.
4
Department of Medicine, Stanford University School of Medicine, Stanford, California.
5
Department of Medicine, University of California, San Francisco, California.
6
Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California; Department of Medicine, Stanford University School of Medicine, Stanford, California. Electronic address: hlatky@stanford.edu.

Abstract

BACKGROUND:

The effectiveness of beta-blockers for preventing cardiac events has been questioned for patients who have coronary heart disease (CHD) without a prior myocardial infarction (MI).

OBJECTIVES:

The purpose of this study was to assess the association of beta-blockers with outcomes among patients with new-onset CHD.

METHODS:

We studied consecutive patients discharged after the first CHD event (acute coronary syndrome or coronary revascularization) between 2000 and 2008 in an integrated healthcare delivery system who did not use beta-blockers in the year before entry. We used time-varying Cox regression models to determine the hazard ratio (HR) associated with beta-blocker treatment and used treatment-by-covariate interaction tests (p(int)) to determine whether the association differed for patients with or without a recent MI.

RESULTS:

A total of 26,793 patients were included, 19,843 of whom initiated beta-blocker treatment within 7 days of discharge from their initial CHD event. Over an average of 3.7 years of follow-up, 6,968 patients had an MI or died. Use of beta-blockers was associated with an adjusted HR for mortality of 0.90 (95% confidence limits [CL]: 0.84 to 0.96), and an adjusted HR for death or MI of 0.92 (CL: 0.87 to 0.97). The association between beta-blockers and outcomes differed significantly between patients with and without a recent MI (HR for death: 0.85 vs. 1.02, p(int) = 0.007; and HR for death or MI: 0.87 vs. 1.03, p(int) = 0.005).

CONCLUSIONS:

Use of beta-blockers among patients with new-onset CHD was associated with a lower risk of cardiac events only among patients with a recent MI.

KEYWORDS:

beta-adrenergic blocking agents; beta-blockers; comparative effectiveness research; outcomes research; treatment effectiveness

PMID:
25034059
DOI:
10.1016/j.jacc.2014.04.042
[Indexed for MEDLINE]
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