Heart failureComparative Effectiveness of Beta-Adrenergic Antagonists (Atenolol, Metoprolol Tartrate, Carvedilol) on the Risk of Rehospitalization in Adults With Heart Failure
Section snippets
Study sample
Patients were identified from Kaiser Permanente of Northern California (Oakland, California), a large integrated health care delivery system providing care for >3.2 million patients, and Harvard Pilgrim Health Care (Boston, Massachusetts), a not-for-profit network-based health plan providing care to >900,000 members. The study was approved by institutional review boards at collaborating institutions and waiver of informed consent was obtained given the nature of the study.
We identified adults
Baseline characteristics in overall cohort and in those receiving versus not receiving beta blockers
During 2001 and 2002, we identified 7,883 eligible survivors of a hospitalization for HF. There was a high prevalence of previous cardiovascular disease and documented vascular risk factors, chronic lung disease, and atrial fibrillation/flutter in cohort members.
Within 30 days before admission, 40% of patients received a β blocker, with the most commonly used being atenolol and metoprolol tartrate, and relatively few patients receiving metoprolol succinate, carvedilol, or other β blockers (
Discussion
Within a large cohort of older adults recently hospitalized with HF, we examined the comparative effectiveness of different β blockers in treated patients. We found that 68% of the cohort received a β blocker at discharge and/or during the first 12 months after discharge, with the most frequently used β blockers in our population being atenolol, shorter-acting metoprolol tartrate, and carvedilol, respectively. In patients with HF receiving β blockers, there were notable differences in
Acknowledgment
We thank Jim Livingston, MBA, Inna Dashevsky, and Ning Hernandez for their expert technical assistance on this study.
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Pharmacological treatments of cardiovascular diseases: Evidence from real-life studies
2017, Pharmacological ResearchCitation Excerpt :The protective effect of BBs on mortality or hospitalization has been confirmed in real-life in CHF patients, regardless of whether ejection fraction (EF) was preserved (EF ≥50%: Hazard Ratio, HR 0.68, 95%CI 0.52; 0.94) or reduced (EF <50%, HR 0.52, 95%CI 0.41; 0.69) [66]., Evidence suggests that there is no substantial difference in term of all-cause mortality and/or hospitalization among the individual BBs [67–69]; moreover, there is no difference between BBs listed in guidelines of CHF (carvedilol, metoprolol, and bisoprolol), and the non-listed ones (atenolol, propranolol, and timolol) [70]. One head-to-head study compared metoprolol and carvedilol.
Data Sources for Heart Failure Comparative Effectiveness Research
2013, Heart Failure ClinicsCitation Excerpt :Among 2929 patients with documented left ventricular systolic dysfunction, no significant adjusted differences were observed among the β-blocker uses. Adjusted hazards of rehospitalization for heart failure within 12 months did not differ significantly among treatment groups.73 The major challenge in linking different data sources is the availability of identifying information in each dataset.
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2009, American Journal of CardiologyCitation Excerpt :However, there was no difference in the decrease seen in cardiovascular mortality or mortality from pump failure between carvedilol and other β blockers. In an observational study by Go et al24 in a subset of patients with left ventricular systolic dysfunction, no statistically significant difference in readmission rates was found with carvedilol compared with atenolol (adjusted HR 1.18, 95% CI 0.70 to 2.01). In the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF) study,25 a secondary analysis demonstrated no statistically significant difference in all-cause mortality at 90 days between carvedilol and nonevidence-based β blockers in patients with an ejection fraction <40% who were recently discharged from the hospital (propensity-adjusted HR 0.70, 95% CI 0.41 to 1.22).
Clinical Effectiveness of Beta-Blockers in Heart Failure. Findings From the OPTIMIZE-HF (Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure) Registry
2009, Journal of the American College of CardiologyCitation Excerpt :Our study strengthens the findings of previous studies by including important clinical characteristics, such as LVEF, and prospective data on eligibility for treatment, including contraindications and intolerance. Go et al. (24) analyzed medical records from 2 health care systems to assess the comparative effectiveness of beta-blockers on the risk of rehospitalization for heart failure. After adjustment for risks of admission and propensity to receive beta-blockers, they did not find significant differences in rehospitalization within 12 months for patients on atenolol, metoprolol tartrate, carvedilol, or other beta-blockers.
This research was conducted by Kaiser Permanente of Northern California and Harvard Pilgrim Health Care under contract to the Agency for Healthcare Research and Quality (Contract HHSA29020050033I), Rockville, Maryland. The authors are responsible for its content. No statement may be construed as the official position of the Agency for Healthcare Research and Quality of the U.S. Department of Health and Human Services.