Abstract 14139: Use of Beta Blockers in Heart Failure: The Impact of Race on the Efficacy of Beta Blocker Therapy
Background: Racial differences in the epidemiology and mortality risk of Heart Failure (HF) have been described, and racial differences may also exist in Beta blocker responsiveness.
Methods: Consecutive patients with ejection fraction (EF) ≤40%, initiated and maintained only on Metoprolol Tartarate (MT), Metoprolol Succinate (MS) or Carvedilol (CD) were enrolled from the Montefiore Heart failure service. We only included Whites and Blacks and race was self reported. Baseline comparisons were done using standard parametric and non-parametric tests. Adjusted Hazards (HR) were estimated using Cox proportional hazard modeling after adjusting for all available demographic, clinical and echocardiographic data.
Results: From Jan 1998 to Dec 2008, 3868 patients (1678 on MT, 1101 on MS and 1089 on CD) were enrolled and followed up until Dec 2010. On average, patients were 64 yrs old, 54% were men, 56% white and 53% had ischemic HF. Incidence of non ischemic heart failure was higher in blacks and there was evidence of effect modification by etiology of heart failure (Ischemic vs. Non Ischemic). Thus, we performed separate analysis for ischemic and non ischemic HF sub groups. Overall, 957 subjects experienced mortality over the 12 year study follow up duration. The hazard of experiencing mortality was lower for whites compared to blacks (HR: 0.77, 95% confidence interval (CI): 0.66 - 0.89 for ischemic HF and HR: 0.86, 95% CI: 0.72-97 for non ischemic HF). Furthermore, greater survival was noted on MS and CD than on MT for both ischemic and non ischemic HF but blacks did better on CD whereas whites did better on MS. Survival on MS was greatest amongst whites with ischemic HF whereas survival with CD was greatest amongst blacks with non ischemic HF.
Conclusion: Beta blocker responsiveness varies by race and subjects. Non selective beta blockers like Carvedilol may be better for blacks especially in non ischemic HF, and Metoprolol succinate may be better for whites with ischemic HF.
- © 2011 by American Heart Association, Inc.