Older adults with heart failure treated with carvedilol, bisoprolol, or metoprolol tartrate: risk of mortality. Issue 1 (16th November 2016)

• Record Type: Journal Article
• Authors: Perreault, Sylvie; de Denus, Simon; White, Michel; White‐Guay, Brian; Bouvier, Michel; Dorais, Marc; Dubé, Marie‐Pierre; Rouleau, Jean‐Lucien; Tardif, Jean‐Claude; Jenna, Sarah; Haibe‐Kains, Benjamin; Leduc, Richard; Deblois, Denis
• Is Part Of: Pharmacoepidemiology and drug safety. Volume 26:Issue 1(2017)
• Page Start: 81
• Page End: 90
• Publication Date: 2016-11-16
• Subjects: β‐blockers -- heart failure -- mortality -- pharmacoepidemiology; Pharmacoepidemiology -- Periodicals; Chemotherapy -- Periodicals; Epidemiology -- Periodicals; 615.705
• DOI: 10.1002/pds.4132
• Languages: English
• ISSNs: 1053-8569

Abstract

Abstract: Purpose: The long‐term use of β ‐blockers has been shown to improve clinical outcomes among patients with heart failure (HF). However, a lack of data persists in assessing whether carvedilol or bisoprolol are superior to metoprolol tartrate in clinical practice. We endeavored to compare the effectiveness of β ‐blockers among older adults following a primary hospital admission for HF. Methods: We conducted a cohort study using Quebec administrative databases to identify patients who were using β ‐blockers, carvedilol, bisoprolol, or metoprolol tartrate after the diagnosis of HF. We characterized the patients by the type of β ‐blocker prescribed at discharge of their first HF hospitalization. An adjusted multivariate Cox proportional hazards model was used to compare the primary outcome of all‐cause mortality. We also conducted analyses by matching for a propensity score for initiation of β ‐blocker therapy and assessed the effect on primary outcome. Results: Among 3197 patients with HF with a median follow‐up of 2.8 years, the crude annual mortality rates (per 100 person‐years) were at 16, 14.9, and 17.7 for metoprolol tartrate, carvedilol, and bisoprolol, respectively. Adjusted hazard ratios of carvedilol (hazard ratio 0.92; 0.78–1.09) and bisoprolol (hazard ratio 1.04; 0.93–1.16) were not significantly different from that of metoprolol tartrate in improving survival. After matching for propensity score, carvedilol and bisoprolol showed no additional benefit with respect to all‐cause mortality compared with metoprolol tartrate. Conclusions: Our evidence suggests no differential effect of β ‐blockers on all‐cause mortality among older adults with HF. Copyright © 2016 John Wiley & Sons, Ltd.