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Pharmacoepidemiol Drug Saf. 2017 Jan;26(1):81-90. doi: 10.1002/pds.4132. Epub 2016 Nov 16.

Older adults with heart failure treated with carvedilol, bisoprolol, or metoprolol tartrate: risk of mortality.

Author information

1
Faculty of Pharmacy, University of Montreal, Montreal, Quebec, Canada.
2
University of Montreal, Montreal, Quebec, Canada.
3
Montreal Heart Institute, Montreal, Quebec, Canada.
4
Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada.
5
Stats Sciences, University of Montreal, Montreal, Quebec, Canada.
6
University of Quebec in Montreal, Montreal, Quebec, Canada.
7
Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.
8
Department of Medical Biophysics, University of Toronto, Toronto, Canada.
9
Department of Computer Science, University of Toronto, Toronto, Canada.
10
University of Sherbrooke, Montreal, Quebec, Canada.
11
Faculty of Medicine, University of Sherbrooke, Quebec, Canada.

Abstract

PURPOSE:

The long-term use of β-blockers has been shown to improve clinical outcomes among patients with heart failure (HF). However, a lack of data persists in assessing whether carvedilol or bisoprolol are superior to metoprolol tartrate in clinical practice. We endeavored to compare the effectiveness of β-blockers among older adults following a primary hospital admission for HF.

METHODS:

We conducted a cohort study using Quebec administrative databases to identify patients who were using β-blockers, carvedilol, bisoprolol, or metoprolol tartrate after the diagnosis of HF. We characterized the patients by the type of β-blocker prescribed at discharge of their first HF hospitalization. An adjusted multivariate Cox proportional hazards model was used to compare the primary outcome of all-cause mortality. We also conducted analyses by matching for a propensity score for initiation of β-blocker therapy and assessed the effect on primary outcome.

RESULTS:

Among 3197 patients with HF with a median follow-up of 2.8 years, the crude annual mortality rates (per 100 person-years) were at 16, 14.9, and 17.7 for metoprolol tartrate, carvedilol, and bisoprolol, respectively. Adjusted hazard ratios of carvedilol (hazard ratio 0.92; 0.78-1.09) and bisoprolol (hazard ratio 1.04; 0.93-1.16) were not significantly different from that of metoprolol tartrate in improving survival. After matching for propensity score, carvedilol and bisoprolol showed no additional benefit with respect to all-cause mortality compared with metoprolol tartrate.

CONCLUSIONS:

Our evidence suggests no differential effect of β-blockers on all-cause mortality among older adults with HF. Copyright © 2016 John Wiley & Sons, Ltd.

KEYWORDS:

heart failure; mortality; pharmacoepidemiology; β-blockers

PMID:
27859924
DOI:
10.1002/pds.4132
[Indexed for MEDLINE]

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