Impact of alpha-adrenergic receptor antagonists use on outcomes in patients with heart failure. A post-hoc analysis using Polish National Health Fund database

Background: The alpha-adrenolytics (AA) are not recommended in patients with ejection fraction (EF) reduced heart failure due to safety concerns. The aim of our study was to assess the safety of AA in patients hospitalized due to exacerbation of HF and the influence of these drugs on long-term endpoints. Material and methods: Data collected by the National Health Fund tracking all patient admissions and taking of the drug prescriptions throughout the entire country was used. Patients hospitalized due to HF exacerbation were included. The primary outcome variable was all-cause mortality and the secondary was the first readmission due to HF or all-cause death occurring more than 30 days after discharge. Results: Of 140 668 patients hospitalized in the year 2013 53 317 were included and followed for a median of 56.3 months. AA patients had lower long-term all-cause mortality (52.8% vs. 54.9%, unadjusted p = 0.038). The treatment with AA positively and independently affected long-term survival [adjusted hazard ratio (adjHR): 0.82, 95% confidence interval (CI): 0.78–0.87, p < 0.001], as well as secondary endpoint (adjHR: 0.85, 95% CI: 0.81–0.90, p < 0.001). Cox analysis in the subgroup treated with beta-blockers revealed that treatment with AA was associated with lower mortality (adjHR: 0.82, 95% CI: 0.75–0.90, p < 0.001) and lower incidence of secondary endpoint (adjHR: 0.85, 95% CI: 0.78–0.92, p < 0.001). Conclusion: In compliant patients hospitalized due to HF exacerbation post discharge treatment with AA was safe and beneficial.