Abstract 10790: Association of Beta Blocker Dose with Outcome in Heart Failure is Not Altered by Age: Insights from the Study of Anemia in a Heart Failure Population (STAMINA-HFP) Registry
Introduction: Beta blockers (BB) improve outcomes in patients (Pts) with heart failure and reduced ejection fraction but little is known about the influence of age on dose response.
Hypothesis: Advancing age diminishes the association of increasing dose of BB with improved outcomes in heart failure.
Methods: The relationship between BB dose and study outcomes, mortality and the combined end point (CE) of mortality + all-cause hospitalization, was investigated in Pts with a history of LVEF < 40 enrolled in the STAMINA-HFP Registry, a prospective, observational study of Pts with heart failure. Total daily doses of BB were converted to mg equivalents of metoprolol succinate. Dose, as a continuous variable, and the risk of adverse outcomes relative to Pts not taking BB was assessed. Risk models were adjusted for clinical characteristics identified earlier as predictors of outcome and potential interactions with age were assessed.
Results: This cohort (n=814) was 37% female, 71% Caucasian, with mean (± SD) age of 63 ± 14 years and LVEF of 30 ± 13. BB were taken in 86% of Pts at a median dose of 100 mg/day. In Pts on BB total daily dose varied substantially with 31% on ≤ 50 mg equivalents, while 43% were taking ≥ 150 mg equivalents. There were 66 deaths and 273 CE during 1.0 ± 0.3 years of follow-up. Adjusted modeling demonstrated a significant curvilinear relationship (p=0.006) between mortality and dose and a linear relationship between CE and dose (p=0.010). Age did not influence this relationship for either mortality (test for interaction p=0.893) or the CE (test for interaction p=0.201). Hazard ratios for the CE in all Pts and Pts ≥ 65 years are shown below for typical mg equivalent doses of metoprolol succinate versus no BB (0 mg).
Conclusion: Increasing BB dose was associated with more favorable outcomes in this retrospective observational analysis of Pts with heart failure and reduced LVEF. Age did not influence the favorable association of increasing BB dose with better outcome.
- © 2010 by American Heart Association, Inc.