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Effect of age and sex on efficacy and tolerability of beta blockers in patients with heart failure with reduced ejection fraction: individual patient data meta-analysis

Författare och institution:
D. Kotecha (-); L. Manzano (-); H. Krum (-); G. Rosano (-); J. Holmes (-); D. G. Altman (-); P. D. Collins (-); M. Packer (-); John Wikstrand (Wallenberglaboratoriet); A. J. S. Coats (-); J. G. F. Cleland (-); P. Kirchhof (-); T. G. von Lueder (-); A. S. Rigby (-); Bert Andersson (Wallenberglaboratoriet); G. Y. H. Lip (-); D. J. van Veldhuisen (-); M. C. Shibata (-); H. Wedel (-); M. Bohm (-); M. D. Flather (-)
Publicerad i:
Bmj-British Medical Journal, 353
ISSN:
1756-1833
Publikationstyp:
Artikel, refereegranskad vetenskaplig
Publiceringsår:
2016
Språk:
engelska
Fulltextlänk:
Sammanfattning (abstract):
OBJECTIVES To determine the efficacy and tolerability of beta blockers in a broad age range of women and men with heart failure with reduced ejection fraction (HFrEF) by pooling individual patient data from placebo controlled randomised trials. Prospectively designed meta-analysis of individual patient data from patients aged 40-85 in sinus rhythm at baseline, with left ventricular ejection fraction < 0.45. The primary outcome was all cause mortality; the major secondary outcome was admission to hospital for heart failure. Analysis was by intention to treat with an adjusted one stage Cox proportional hazards model. Compared with placebo, beta blockers were effective in reducing mortality across all ages: hazard ratios were 0.66 (95% confidence interval 0.53 to 0.83) for the first quarter of age distribution (median age 50); 0.71 (0.58 to 0.87) for the second quarter (median age 60); 0.65 (0.53 to 0.78) for the third quarter (median age 68); and 0.77 (0.64 to 0.92) for the fourth quarter (median age 75). There was no significant interaction when age was modelled continuously (P=0.1), and the absolute reduction in mortality was 4.3% over a median follow-up of 1.3 years (number needed to treat 23). Admission to hospital for heart failure was significantly reduced by beta blockers, although this effect was attenuated at older ages (interaction P=0.05). There was no evidence of an interaction between treatment effect and sex in any age group. Drug discontinuation was similar regardless of treatment allocation, age, or sex (14.4% in those give beta blockers, 15.6% in those receiving placebo). Irrespective of age or sex, patients with HFrEF in sinus rhythm should receive beta blockers to reduce the risk of death and admission to hospital.
Ämne (baseras på Högskoleverkets indelning av forskningsämnen):
MEDICIN OCH HÄLSOVETENSKAP ->
Klinisk medicin ->
Kardiologi ->
Kardiovaskulär medicin
Nyckelord:
randomized intervention trial, cardiac-insufficiency bisoprolol, left-ventricular dysfunction, atrial-fibrillation, metoprolol cr/xl, elderly-patients, merit-hf, myocardial-infarction, event outcomes, carvedilol, General & Internal Medicine
Postens nummer:
236915
Posten skapad:
2016-05-25 14:38

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