Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
Division of Cardiology, Cardiovascular Department, Azienda Sanitaria Universitaria Integrata di Trieste (ASUITS), Trieste, Italy.
Eur J Heart Fail. 2020 Jan;22(1):103-112. doi: 10.1002/ejhf.1615. Epub 2019 Oct 23.
Beta-blockers reduce mortality and morbidity in heart failure (HF) with reduced ejection fraction (HFrEF). However, patients older than 80 years are poorly represented in randomized controlled trials. We assessed the association between beta-blocker use and outcomes in HFrEF patients aged ≥80 years.
We included patients with an ejection fraction <40% and aged ≥80 years from the Swedish HF Registry. The association between beta-blocker use, all-cause mortality and cardiovascular (CV) mortality/HF hospitalization was assessed by Cox proportional hazard models in a 1:1 propensity score-matched cohort. To assess consistency, the same analyses were performed in a positive control cohort with age <80 years. A negative control outcome analysis was run using hospitalization for cancer as endpoint. Of 6562 patients aged ≥80 years, 5640 (86%) received beta-blockers. In the matched cohort including 1732 patients, beta-blocker use was associated with a significant reduction in the risk of all-cause mortality [hazard ratio (HR) 0.89, 95% confidence interval (CI) 0.79-0.99]. Reduction in CV mortality/HF hospitalization was not significant (HR 0.94, 95% CI 0.85-1.05) due to the lack of association with HF hospitalization, whereas CV death was significantly reduced. After adjustment rather than matching for the propensity score in the overall cohort, beta-blocker use was associated with reduced risk of all outcomes. In patients aged <80 years, use of beta-blockers was associated with reduced risk of all-cause death (HR 0.79, 95% CI 0.68-0.92) and of the composite outcome (HR 0.88, 95% CI 0.77-0.99).
In HFrEF patients ≥80 years of age, use of beta-blockers was high and was associated with improved all-cause and CV survival.
β受体阻滞剂可降低射血分数降低的心力衰竭（HFrEF）患者的死亡率和发病率。然而，在随机对照试验中，80 岁以上的患者代表性较差。我们评估了β受体阻滞剂在 80 岁以上 HFrEF 患者中的使用与结局的相关性。
我们纳入了来自瑞典心力衰竭注册研究的射血分数<40%且年龄≥80 岁的患者。通过 Cox 比例风险模型在 1:1 倾向评分匹配队列中评估β受体阻滞剂使用与全因死亡率和心血管（CV）死亡率/心力衰竭住院之间的关系。为了评估一致性，在年龄<80 岁的阳性对照队列中进行了相同的分析。使用癌症住院作为终点进行了阴性对照结局分析。在≥80 岁的 6562 名患者中，5640 名（86%）接受了β受体阻滞剂治疗。在纳入 1732 名患者的匹配队列中，β受体阻滞剂的使用与全因死亡率风险降低显著相关[风险比（HR）0.89，95%置信区间（CI）0.79-0.99]。由于与心力衰竭住院无关，CV 死亡率/心力衰竭住院的降低不显著（HR 0.94，95%CI 0.85-1.05），而 CV 死亡则显著降低。在整个队列中，在不进行倾向评分匹配而进行调整后，β受体阻滞剂的使用与所有结局的风险降低相关。在年龄<80 岁的患者中，β受体阻滞剂的使用与全因死亡风险降低相关（HR 0.79，95%CI 0.68-0.92）和复合结局风险降低相关（HR 0.88，95%CI 0.77-0.99）。
在 80 岁以上的 HFrEF 患者中，β受体阻滞剂的使用率较高，与全因和心血管生存改善相关。
