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(Circulation. 2006;113:1086-1092.)
© 2006 American Heart Association, Inc.

Heart Failure

Statins and Mortality Among Elderly Patients Hospitalized With Heart Failure

JoAnne Micale Foody, MD; Rahman Shah, MD; Deron Galusha, MS; Frederick A. Masoudi, MD, MSPH; Edward P. Havranek, MD; Harlan M. Krumholz, MD

From the Section of Cardiovascular Medicine, Department of Internal Medicine (J.M.F., R.S., D.G., H.M.K.), and Section of Health Policy and Administration, Department of Epidemiology and Public Health (H.M.K.), Yale University School of Medicine, New Haven, Conn; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Conn (J.M.F., D.G., H.M.K.); West Haven Veterans Administration Medical Center, West Haven, Conn (J.M.F., R.S.); Colorado Foundation for Medical Care, Aurora (J.M.F., F.A.M., H.M.K.); Qualidigm, Middletown, Conn (J.M.F, H.M.K); Division of Cardiology, Department of Medicine, Denver Health Medical Center, Denver, Colo (F.A.M.); and Divisions of Cardiology and Geriatric Medicine, Department of Medicine, University of Colorado Health Sciences Center, Denver (F.A.M.).

Correspondence to JoAnne M. Foody, MD, Yale University School of Medicine, 333 Cedar St, Room 315B FMP, New Haven, CT 06520-8025. E-mail joanne.foody{at}yale.edu

Received October 3, 2005; revision received December 13, 2005; accepted December 21, 2005.

Background— Small studies suggest that statins may improve mortality in patients with heart failure (HF). Whether these results are generalizable to a broader group of patients with HF remains unclear. Our objective was to evaluate the association between statin use and survival among a national sample of elderly patients hospitalized with HF.

Methods and Results— A nationwide sample of 61 939 eligible Medicare beneficiaries 65 years of age who were hospitalized with a primary discharge diagnosis of HF between April 1998 and March 1999 or July 2000 and June 2001 was evaluated. The analysis was restricted to patients with no contraindications to statins (n=54 960). Of these patients, only 16.7% received statins on discharge. Older patients were less likely to receive a statin at discharge. Patients with hyperlipidemia and those cared for by a cardiologist or cared for in a teaching hospital were more likely to receive a statin at discharge. In a Cox proportional hazards model that took into account demographic, clinical characteristics, treatments, physician specialty, and hospital characteristics, discharge statin therapy was associated with significant improvements in 1- and 3-year mortality (hazard ratio, 0.80; 95% CI, 0.76 to 0.84; and hazard ratio, 0.82; 95% CI, 0.79 to 0.85, respectively). Regardless of total cholesterol level or coronary artery disease status, statin therapy was associated with significant differences in mortality.

Conclusions— Our data demonstrate that statin therapy is associated with better long-term mortality in older patients with HF. This study suggests a potential role for statins as an adjunct to current HF therapy. Randomized clinical trials are required to determine the role of these agents in improving outcomes in the large and growing group of patients with HF.

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