Clinical Effectiveness of Beta-Blockers in Heart Failure

Objectives We sought to examine associations between initiation of beta-blocker therapy and outcomes among elderly patients hospitalized for heart failure. Background Beta-blockers are guideline-recommended therapy for heart failure, but their clinical effectiveness is not well-understood, especially in elderly patients. Methods We merged Medicare claims data with OPTIMIZE-HF records to examine long-term outcomes of eligible patients newly initiated on beta-blocker therapy. We used inverse probability-weighted Cox proportional hazards models to determine the relationships between treatment and mortality, rehospitalization, and a combined mortality–rehospitalization endpoint. Results Observed 1-year mortality was 33%, and all-cause rehospitalization was 64%. Among 7154 patients hospitalized with heart failure and eligible for beta-blockers, 3421 (49%) were newly initiated on beta-blocker therapy. Among patients with left ventricular systolic dysfunction (LVSD; n = 3001), beta-blockers were associated with adjusted hazard ratios of 0.77 (95% confidence interval CI, 0.68–0.87) for mortality, 0.89 (95% CI, 0.80–0.99) for rehospitalization, and 0.87 (95% CI, 0.79–0.96) for mortality–rehospitalization. Among patients with preserved systolic function (n = 4153), beta-blockers were associated with adjusted hazard ratios of 0.94 (95% CI, 0.84–1.07) for mortality, 0.98 (95% CI, 0.90–1.06) for rehospitalization, and 0.98 (95% CI, 0.91–1.06) for mortality-rehospitalization. Conclusions In elderly patients hospitalized with heart failure and LVSD, incident beta-blocker use was clinically effective and independently associated with lower risks of death and rehospitalization. Patients with preserved systolic function had poor outcomes, and beta-blockers did not significantly influence the mortality and rehospitalization risks for these patients.