Abstract 20236: Effect of Carvedilol on Outcomes in Medicare Beneficiaries with Heart Failure: A Propensity-Matched Study
Background: Carvedilol, a nonselective beta-blocker with vasodilating and antioxidant properties, has been shown to reduce mortality in patients with systolic heart failure (HF). However, most randomized clinical trials of carvedilol excluded older adults and those with diastolic HF. We examined if the discharge prescription of carvedilol would reduce mortality in older adults hospitalized for acute decompensated HF.
Methods: Charts of 8049 hospitalized Medicare beneficiaries discharged alive with a primary discharge diagnosis of HF from 106 US hospitals in 1998–2001 were abstracted. Patient receiving other beta-blockers (n=1798) were excluded. Of the 6251 patients in the final study sample, 638 patients received carvedilol. Propensity for discharge prescription of carvedilol was estimated for each of the 6251 patients using a non-parsimonious multivariable logistic regression model, and was used to assemble a cohort of 631 pairs of patients receiving and not receiving carvedilol, who were balanced on 38 baseline characteristics. Stratified Cox regression models were used to estimate association of carvedilol use with all-cause mortality and HF hospitalization during over 8 years of follow-up.
Results: Patients had a mean (±SD) age of 76 (±11) years, 57% women, 25% African American. All-cause mortality occurred in 65% and 71% of matched patients in the carvedilol and no-carvedilol group respectively (matched hazard ratio, 0.80; 95% CI, 0.68–0.95; p=0.010; Figure). There was no interaction between carvedilol use and left ventricular ejection fraction (p for interaction, 0.775). Carvedilol use had no association with HF hospitalization.
Conclusions: Discharge prescription of carvedilol was associated with reduced mortality in Medicare beneficiaries hospitalized with HF.
- © 2010 by American Heart Association, Inc.