PMID- 27098105
OWN - NLM
STAT- MEDLINE
DCOM- 20160830
LR  - 20170922
IS  - 1756-1833 (Electronic)
IS  - 0959-8138 (Linking)
VI  - 353
DP  - 2016 Apr 20
TI  - Effect of age and sex on efficacy and tolerability of beta blockers in patients
      with heart failure with reduced ejection fraction: individual patient data
      meta-analysis.
PG  - i1855
LID - 10.1136/bmj.i1855 [doi]
AB  - OBJECTIVES: To determine the efficacy and tolerability of beta blockers in a
      broad age range of women and men with heart failure with reduced ejection
      fraction (HFrEF) by pooling individual patient data from placebo controlled
      randomised trials. DESIGN: Prospectively designed meta-analysis of individual
      patient data from patients aged 40-85 in sinus rhythm at baseline, with left
      ventricular ejection fraction <0.45. PARTICIPANTS: 13,833 patients from 11
      trials; median age 64; 24% women. MAIN OUTCOME MEASURES: The primary outcome was 
      all cause mortality; the major secondary outcome was admission to hospital for
      heart failure. Analysis was by intention to treat with an adjusted one stage Cox 
      proportional hazards model. RESULTS: Compared with placebo, beta blockers were
      effective in reducing mortality across all ages: hazard ratios were 0.66 (95%
      confidence interval 0.53 to 0.83) for the first quarter of age distribution
      (median age 50); 0.71 (0.58 to 0.87) for the second quarter (median age 60); 0.65
      (0.53 to 0.78) for the third quarter (median age 68); and 0.77 (0.64 to 0.92) for
      the fourth quarter (median age 75). There was no significant interaction when age
      was modelled continuously (P=0.1), and the absolute reduction in mortality was
      4.3% over a median follow-up of 1.3 years (number needed to treat 23). Admission 
      to hospital for heart failure was significantly reduced by beta blockers,
      although this effect was attenuated at older ages (interaction P=0.05). There was
      no evidence of an interaction between treatment effect and sex in any age group. 
      Drug discontinuation was similar regardless of treatment allocation, age, or sex 
      (14.4% in those give beta blockers, 15.6% in those receiving placebo).
      CONCLUSION: Irrespective of age or sex, patients with HFrEF in sinus rhythm
      should receive beta blockers to reduce the risk of death and admission to
      hospital.Registration PROSPERO CRD42014010012; Clinicaltrials.gov NCT00832442.
CI  - Published by the BMJ Publishing Group Limited. For permission to use (where not
      already granted under a licence) please go to
      http://group.bmj.com/group/rights-licensing/permissions.
FAU - Kotecha, Dipak
AU  - Kotecha D
AD  - University of Birmingham Institute of Cardiovascular Sciences, Birmingham, UK
      Centre of Cardiovascular Research and Education in Therapeutics, Monash
      University, Melbourne, Australia d.kotecha@bham.ac.uk.
FAU - Manzano, Luis
AU  - Manzano L
AD  - Internal Medicine Department, Hospital Universitario Ramon y Cajal, Universidad
      de Alcala, Madrid, Spain.
FAU - Krum, Henry
AU  - Krum H
AD  - Centre of Cardiovascular Research and Education in Therapeutics, Monash
      University, Melbourne, Australia.
FAU - Rosano, Giuseppe
AU  - Rosano G
AD  - Department of Medical Sciences, IRCCS San Raffaele Pisana, Roma, Italy
      Cardiovascular and Cell Science Institute, St George's University of London,
      London, UK.
FAU - Holmes, Jane
AU  - Holmes J
AD  - Centre for Statistics in Medicine, Nuffield Department of Orthopaedics,
      Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
FAU - Altman, Douglas G
AU  - Altman DG
AD  - Centre for Statistics in Medicine, Nuffield Department of Orthopaedics,
      Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
FAU - Collins, Peter D
AU  - Collins PD
AD  - National Heart and Lung Institute, Imperial College, London, UK.
FAU - Packer, Milton
AU  - Packer M
AD  - Baylor University Medical Center, Dallas, USA.
FAU - Wikstrand, John
AU  - Wikstrand J
AD  - Wallenberg Laboratory for Cardiovascular Research, Sahlgrenska Academy,
      Gothenburg University, Gothenburg, Sweden.
FAU - Coats, Andrew J S
AU  - Coats AJ
AD  - Monash Warwick Alliance, Monash University, Melbourne, Australia Monash Warwick
      Alliance, University of Warwick, Warwick, UK.
FAU - Cleland, John G F
AU  - Cleland JG
AD  - National Heart and Lung Institute, Imperial College, London, UK.
FAU - Kirchhof, Paulus
AU  - Kirchhof P
AD  - University of Birmingham Institute of Cardiovascular Sciences, Birmingham, UK.
FAU - von Lueder, Thomas G
AU  - von Lueder TG
AD  - Department of Cardiology, Oslo University Hospital, Oslo, Norway.
FAU - Rigby, Alan S
AU  - Rigby AS
AD  - Academic Cardiology, Castle Hill Hospital, Kingston upon Hull, UK.
FAU - Andersson, Bert
AU  - Andersson B
AD  - Wallenberg Laboratory for Cardiovascular Research, Sahlgrenska Academy,
      Gothenburg University, Gothenburg, Sweden.
FAU - Lip, Gregory Y H
AU  - Lip GY
AD  - University of Birmingham Institute of Cardiovascular Sciences, Birmingham, UK.
FAU - van Veldhuisen, Dirk J
AU  - van Veldhuisen DJ
AD  - Department of Cardiology, University Medical Centre Groningen, University of
      Groningen, Groningen, Netherlands.
FAU - Shibata, Marcelo C
AU  - Shibata MC
AD  - Division of Cardiology, University of Alberta, Edmonton, Canada.
FAU - Wedel, Hans
AU  - Wedel H
AD  - Nordic School of Public Health, Gothenburg, Sweden.
FAU - Bohm, Michael
AU  - Bohm M
AD  - Universitatsklinikum des Saarlandes, Homburg/Saar, Germany.
FAU - Flather, Marcus D
AU  - Flather MD
AD  - Norwich Medical School, University of East Anglia, Norwich, UK.
CN  - Beta-Blockers in Heart Failure Collaborative Group
LA  - eng
SI  - ClinicalTrials.gov/NCT00832442
GR  - CDF-2015-08-074/Department of Health/United Kingdom
GR  - FS/13/43/30324/British Heart Foundation/United Kingdom
PT  - Journal Article
PT  - Meta-Analysis
PT  - Research Support, Non-U.S. Gov't
PT  - Review
DEP - 20160420
PL  - England
TA  - BMJ
JT  - BMJ (Clinical research ed.)
JID - 8900488
RN  - 0 (Adrenergic beta-Antagonists)
SB  - AIM
SB  - IM
CIN - BMJ. 2016;353:i2074. PMID: 27099266
MH  - Adrenergic beta-Antagonists/*therapeutic use
MH  - Adult
MH  - Age Factors
MH  - Aged
MH  - Aged, 80 and over
MH  - Female
MH  - Heart Failure/*drug therapy/physiopathology
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Sex Factors
MH  - Stroke Volume/physiology
MH  - Treatment Outcome
PMC - PMC4849174
EDAT- 2016/04/22 06:00
MHDA- 2016/08/31 06:00
CRDT- 2016/04/22 06:00
PHST- 2016/04/22 06:00 [entrez]
PHST- 2016/04/22 06:00 [pubmed]
PHST- 2016/08/31 06:00 [medline]
PST - epublish
SO  - BMJ. 2016 Apr 20;353:i1855.