Abstract 18473: Filling a β-blocker in the Week After Discharge for a Heart Failure Hospitalization is Associated With a Lower Risk of Rehospitalization Among Medicare Beneficiaries
Introduction: In clinical trial populations with heart failure (HF) and reduced ejection fraction, there is evidence that the β-blockers metoprolol succinate, carvedilol, and bisoprolol reduce mortality and hospitalizations. The short-term impact of β-blockers among typical hospitalized HF patients with heavy comorbidity burdens is less clear.
Hypothesis: Filling a β-blocker within 7 days of HF hospitalization is associated with lower rehospitalization risk 8-30 days after discharge.
Methods: We identified 76,568 HF hospitalizations in the Medicare national 5% sample among beneficiaries with fee-for-service and medication coverage (20,358 with documented systolic dysfunction). Beneficiary characteristics, β-blocker fills, and rehospitalization for HF, cardiovascular disease (CVD), or any cause were assessed through Medicare claims. We used generalized estimating equations to calculate multivariable-adjusted risk ratios for rehospitalization.
Results: The average age was 76 years, 61% were women, and 19% were black. Comorbidities were common (hypertension 85%, coronary heart disease 70%, chronic kidney disease 65%, chronic obstructive pulmonary disease 57%, diabetes 53%, atrial fibrillation 48%, depression 25%, hypotension 21%, valvular or rheumatic heart disease 15%). Almost all had prior diagnoses of HF (99%). Within 7 days of discharge, 25% filled any β-blocker and 17% filled metoprolol succinate, carvedilol, or bisoprolol. In the 8-30 days following discharge, 9% were rehospitalized for HF, 12% for CVD, and 22% for any cause. Filling a β-blocker was associated with a lower risk rehospitalization for HF, CVD, and any cause in both the overall population and the subgroup with documented systolic dysfunction (Table).
Conclusions: Medicare beneficiaries with HF who filled β-blockers shortly after discharge had better short-term prognosis; however, risk of rehospitalization among those with and without β-blocker fills was high.
Author Disclosures: E.B. Levitan: Research Grant; Significant; Amgen. Consultant/Advisory Board; Significant; Robinson Calcagnie Robinson Shapiro Davis. M.K. Van Dyke: Employment; Significant; Amgen. L. Chen: Research Grant; Significant; Amgen. R.W. Durant: Research Grant; Modest; Amgen. T.M. Brown: Research Grant; Modest; Amgen. M.M. Safford: Research Grant; Significant; Amgen. M.L. Kilgore: Research Grant; Significant; Amgen.
- © 2015 by American Heart Association, Inc.