AI Article Synopsis
- The demographics of heart failure are shifting, with a notable increase in patients aged 75 and older, who were previously underrepresented in beta-blocker trials due to varying risks and benefits.
- This study analyzed Medicare data to assess the impact of beta-blocker treatment on 90-day mortality and readmission rates for heart failure with reduced ejection fraction (HFrEF) among older patients.
- Results showed that patients aged 75+ who received a beta-blocker post-discharge had significant reductions in both 90-day mortality (4.78%) and readmission rates (4.67%), suggesting that age does not diminish the benefits of beta-blocker therapy.
Article Abstract
Background: The demographics of heart failure are changing. The rate of growth of the "older" heart failure population, specifically those ≥ 75, has outpaced that of any other age group. These older patients were underrepresented in the early beta-blocker trials. There are several reasons, including a decreased potential for mortality benefit and increased risk of side effects, why the risk/benefit tradeoff may be different in this population.
Objective: We aimed to determine the association between receipt of a beta-blocker after heart failure discharge and early mortality and readmission rates among patients with heart failure and reduced ejection fraction (HFrEF), specifically patients aged 75+.
Design And Participants: We used 100% Medicare Parts A and B and a random 40% sample of Part D to create a cohort of beneficiaries with ≥ 1 hospitalization for HFrEF between 2008 and 2016 to run an instrumental variable analysis.
Main Measure: The primary measure was 90-day, all-cause mortality; the secondary measure was 90-day, all-cause readmission.
Key Results: Using the two-stage least squared methodology, among all HFrEF patients, receipt of a beta-blocker within 30-day of discharge was associated with a - 4.35% (95% CI - 6.27 to - 2.42%, p < 0.001) decrease in 90-day mortality and a - 4.66% (95% CI - 7.40 to - 1.91%, p = 0.001) decrease in 90-day readmission rates. Even among patients ≥ 75 years old, receipt of a beta-blocker at discharge was also associated with a significant decrease in 90-day mortality, - 4.78% (95% CI - 7.19 to - 2.40%, p < 0.001) and 90-day readmissions, - 4.67% (95% CI - 7.89 to - 1.45%, p < 0.001).
Conclusion: Patients aged ≥ 75 years who receive a beta-blocker after HFrEF hospitalization have significantly lower 90-day mortality and readmission rates. The magnitude of benefit does not appear to wane with age. Absent a strong contraindication, all patients with HFrEF should attempt beta-blocker therapy at/after hospital discharge, regardless of age.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8342662 | PMC |
| http://dx.doi.org/10.1007/s11606-021-06901-7 | DOI Listing |
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