Among Medicare beneficiaries with HFrEF aged ≥85 years, use of beta-blockers and ACEi/ARBs was associated with significantly lower 30-day mortality (HR 0.59 and HR 0.47, respectively).
Cohort (n=295,494)
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Does neurohormonal therapy reduce short- and long-term mortality in older adults with HFrEF?
Neurohormonal therapy with beta-blockers and ACEi/ARBs is associated with significantly lower 30-day and 1-year mortality in older adults with HFrEF, including those aged ≥85 years.
Hazard Ratio: 0.59 (95% CI 0.56–0.62)
valor p: p=<0.001
BACKGROUND/OBJECTIVES: Neurohormonal therapy, which includes beta-blockers and angiotensin-converting enzyme inhibitor/angiotensin receptor blockers (ACEi/ARBs), is the cornerstone of heart failure with reduced ejection fraction (HFrEF) treatment. While neurohormonal therapies have demonstrated efficacy in randomized clinical trials, older patients, which now comprise the majority of HFrEF patients, were underrepresented in those original trials. This study aimed to determine the association between short- (30 day) and long-term (1 year) mortality and the use of neurohormonal therapy in HFrEF patients, across the age spectrum. DESIGN/SETTING/PARTICIPANTS: This is a population-based, retrospective, cohort study between January 2008 and December 2015. We used 100% Medicare Parts A and B and a random 40% sample of Part D to create a cohort of 295,494 fee-for-service beneficiaries with at least one hospitalization for HFrEF between 2008 and 2015. All analyses were performed between May 2019 and July 2020. EXPOSURE: We used Part D data to determine exposure to beta-blocker and ACEi and ARB therapy. RESULTS: We found that in 295,494 patients admitted for HFrEF between 2008 and 2015, the average age was 80 years, 54% were female and 17% were non-white. The baseline mortality rate was higher among those aged ≥85, but the mortality benefits of neurohormonal therapy were preserved across the age spectrum. Among those ≥85 years old, the hazard ratio for death within 30 days was 0.59 (95% confidence interval CI 0.56-0.62; p < 0.001) for beta-blockers and 0.47 (95% CI 0.44-0.49; p < 0.001) for ACEi/ARBs. The hazard ratio for death within 1 year was 0.37-0.56 (95% CI 0.35-0.58; p < 0.001) for beta-blockers and 0.38-0.53 (95% CI 0.37-0.55; p < 0.001) for ACEi/ARB. CONCLUSION: At a population level, neurohormonal therapy was associated with lower short- and long-term mortality across the age spectrum.
Gilstrap et al. (Tue,) llevaron a cabo una cohorte en insuficiencia cardíaca con fracción de eyección reducida (ICFER) (n=295,494). Se evaluó la terapia neurohormonal (betabloqueantes e IECA/ARA) frente a ninguna terapia neurohormonal sobre la muerte en 30 días (para betabloqueantes en pacientes ≥85 años) (HR 0.59, IC 95% 0.56-0.62, p=<0.001). Entre los beneficiarios de Medicare con ICFER de ≥85 años, el uso de betabloqueantes e IECA/ARA se asoció con una mortalidad significativamente menor a 30 días (HR 0.59 y HR 0.47, respectivamente).
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