Dose-dependent efficacy of β-blocker in patients with chronic heart failure and atrial fibrillation

MECKI Score Research Group

Research output: Contribution to journalArticle

Abstract

BACKGROUND: The usefulness of β-blockers in heart failure (HF) patients with permanent atrial fibrillation (AF) has been questioned.

METHODS AND RESULTS: We analyzed data from HF patients (958 patients (801 males, 84%, age 67 ± 11 years)) with AF enrolled in the MECKI score database. We evaluated prognosis (composite of cardiovascular death, urgent heart transplant, or left ventricular assist device) of patients receiving β-blockers (n = 777, 81%) vs. those not treated with β-blockers (n = 181, 19%). We also analyzed the role β1-selectivity and the role of daily β-blocker dose. To account for different HF severity, Kaplan-Meier survival curves were normalized for relevant confounding factors and for treatment strategies. Dose was available in 629 patients. Median follow-up was 1312 (577-2304) days in the entire population, 1203 (614-2420) and 1325 (569-2300) days in patients not receiving and receiving β-blockers. 224 (23%, 54/1000 events/year), 163 (21%, 79/1000 events/year), and 61 (34%, 49/1000 events/year) events were recorded, respectively. At 10-year patients treated with β-blockers had a better outcome (HR 0.447, p < 0.01) with no effects as regards β1selective drugs (53%) vs. β1-β2 blockers (47%). Survival improved in parallel with β-blocker dose increase (HR 0.296, 0.496, 0.490 for the high, medium, and low dose vs. no β-blockers, p < 0.0001).

CONCLUSION: HF patients with AF taking a β-blocker have a better outcome (with a survival improvement in parallel with daily dose but no differences as regards β1 selectivity) but this does not mean that β-blockers improve outcomes in these patients as we cannot control for all the potential confounders associated with β-blocker use.

Original languageEnglish
Pages (from-to)141-146
Number of pages6
JournalInternational Journal of Cardiology
Volume273
DOIs
Publication statusPublished - Dec 15 2018

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Atrial Fibrillation
Heart Failure
Heart-Assist Devices
Survival
Kaplan-Meier Estimate
Databases
Transplants
Pharmaceutical Preparations
Population

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Dose-dependent efficacy of β-blocker in patients with chronic heart failure and atrial fibrillation. / MECKI Score Research Group.

In: International Journal of Cardiology, Vol. 273, 15.12.2018, p. 141-146.

Research output: Contribution to journalArticle

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title = "Dose-dependent efficacy of β-blocker in patients with chronic heart failure and atrial fibrillation",
abstract = "BACKGROUND: The usefulness of β-blockers in heart failure (HF) patients with permanent atrial fibrillation (AF) has been questioned.METHODS AND RESULTS: We analyzed data from HF patients (958 patients (801 males, 84{\%}, age 67 ± 11 years)) with AF enrolled in the MECKI score database. We evaluated prognosis (composite of cardiovascular death, urgent heart transplant, or left ventricular assist device) of patients receiving β-blockers (n = 777, 81{\%}) vs. those not treated with β-blockers (n = 181, 19{\%}). We also analyzed the role β1-selectivity and the role of daily β-blocker dose. To account for different HF severity, Kaplan-Meier survival curves were normalized for relevant confounding factors and for treatment strategies. Dose was available in 629 patients. Median follow-up was 1312 (577-2304) days in the entire population, 1203 (614-2420) and 1325 (569-2300) days in patients not receiving and receiving β-blockers. 224 (23{\%}, 54/1000 events/year), 163 (21{\%}, 79/1000 events/year), and 61 (34{\%}, 49/1000 events/year) events were recorded, respectively. At 10-year patients treated with β-blockers had a better outcome (HR 0.447, p < 0.01) with no effects as regards β1selective drugs (53{\%}) vs. β1-β2 blockers (47{\%}). Survival improved in parallel with β-blocker dose increase (HR 0.296, 0.496, 0.490 for the high, medium, and low dose vs. no β-blockers, p < 0.0001).CONCLUSION: HF patients with AF taking a β-blocker have a better outcome (with a survival improvement in parallel with daily dose but no differences as regards β1 selectivity) but this does not mean that β-blockers improve outcomes in these patients as we cannot control for all the potential confounders associated with β-blocker use.",
author = "{MECKI Score Research Group} and Jeness Campodonico and Massimo Piepoli and Francesco Clemenza and Alice Bonomi and Stefania Paolillo and Elisabetta Salvioni and Ugo Corr{\`a} and Simone Binno and Fabrizio Veglia and Rocco Lagioia and Gianfranco Sinagra and Gaia Cattadori and Scardovi, {Angela B} and Marco Metra and Michele Senni and Domenico Scrutinio and Rosa Raimondo and Michele Emdin and Damiano Magr{\`i} and Gianfranco Parati and Federica Re and Mariantonietta Cicoira and Chiara Min{\`a} and Giuseppe Limongelli and Michele Correale and Maria Frigerio and Maurizio Bussotti and Enrico Perna and Elisa Battaia and Marco Guazzi and Roberto Badagliacca and {Di Lenarda}, Andrea and Aldo Maggioni and Claudio Passino and Susanna Sciomer and Giuseppe Pacileo and Massimo Mapelli and Carlo Vignati and Carlo Lombardi and Filardi, {Pasquale Perrone} and Piergiuseppe Agostoni",
note = "Copyright {\circledC} 2018. Published by Elsevier B.V.",
year = "2018",
month = "12",
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doi = "10.1016/j.ijcard.2018.08.012",
language = "English",
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T1 - Dose-dependent efficacy of β-blocker in patients with chronic heart failure and atrial fibrillation

AU - MECKI Score Research Group

AU - Campodonico, Jeness

AU - Piepoli, Massimo

AU - Clemenza, Francesco

AU - Bonomi, Alice

AU - Paolillo, Stefania

AU - Salvioni, Elisabetta

AU - Corrà, Ugo

AU - Binno, Simone

AU - Veglia, Fabrizio

AU - Lagioia, Rocco

AU - Sinagra, Gianfranco

AU - Cattadori, Gaia

AU - Scardovi, Angela B

AU - Metra, Marco

AU - Senni, Michele

AU - Scrutinio, Domenico

AU - Raimondo, Rosa

AU - Emdin, Michele

AU - Magrì, Damiano

AU - Parati, Gianfranco

AU - Re, Federica

AU - Cicoira, Mariantonietta

AU - Minà, Chiara

AU - Limongelli, Giuseppe

AU - Correale, Michele

AU - Frigerio, Maria

AU - Bussotti, Maurizio

AU - Perna, Enrico

AU - Battaia, Elisa

AU - Guazzi, Marco

AU - Badagliacca, Roberto

AU - Di Lenarda, Andrea

AU - Maggioni, Aldo

AU - Passino, Claudio

AU - Sciomer, Susanna

AU - Pacileo, Giuseppe

AU - Mapelli, Massimo

AU - Vignati, Carlo

AU - Lombardi, Carlo

AU - Filardi, Pasquale Perrone

AU - Agostoni, Piergiuseppe

N1 - Copyright © 2018. Published by Elsevier B.V.

PY - 2018/12/15

Y1 - 2018/12/15

N2 - BACKGROUND: The usefulness of β-blockers in heart failure (HF) patients with permanent atrial fibrillation (AF) has been questioned.METHODS AND RESULTS: We analyzed data from HF patients (958 patients (801 males, 84%, age 67 ± 11 years)) with AF enrolled in the MECKI score database. We evaluated prognosis (composite of cardiovascular death, urgent heart transplant, or left ventricular assist device) of patients receiving β-blockers (n = 777, 81%) vs. those not treated with β-blockers (n = 181, 19%). We also analyzed the role β1-selectivity and the role of daily β-blocker dose. To account for different HF severity, Kaplan-Meier survival curves were normalized for relevant confounding factors and for treatment strategies. Dose was available in 629 patients. Median follow-up was 1312 (577-2304) days in the entire population, 1203 (614-2420) and 1325 (569-2300) days in patients not receiving and receiving β-blockers. 224 (23%, 54/1000 events/year), 163 (21%, 79/1000 events/year), and 61 (34%, 49/1000 events/year) events were recorded, respectively. At 10-year patients treated with β-blockers had a better outcome (HR 0.447, p < 0.01) with no effects as regards β1selective drugs (53%) vs. β1-β2 blockers (47%). Survival improved in parallel with β-blocker dose increase (HR 0.296, 0.496, 0.490 for the high, medium, and low dose vs. no β-blockers, p < 0.0001).CONCLUSION: HF patients with AF taking a β-blocker have a better outcome (with a survival improvement in parallel with daily dose but no differences as regards β1 selectivity) but this does not mean that β-blockers improve outcomes in these patients as we cannot control for all the potential confounders associated with β-blocker use.

AB - BACKGROUND: The usefulness of β-blockers in heart failure (HF) patients with permanent atrial fibrillation (AF) has been questioned.METHODS AND RESULTS: We analyzed data from HF patients (958 patients (801 males, 84%, age 67 ± 11 years)) with AF enrolled in the MECKI score database. We evaluated prognosis (composite of cardiovascular death, urgent heart transplant, or left ventricular assist device) of patients receiving β-blockers (n = 777, 81%) vs. those not treated with β-blockers (n = 181, 19%). We also analyzed the role β1-selectivity and the role of daily β-blocker dose. To account for different HF severity, Kaplan-Meier survival curves were normalized for relevant confounding factors and for treatment strategies. Dose was available in 629 patients. Median follow-up was 1312 (577-2304) days in the entire population, 1203 (614-2420) and 1325 (569-2300) days in patients not receiving and receiving β-blockers. 224 (23%, 54/1000 events/year), 163 (21%, 79/1000 events/year), and 61 (34%, 49/1000 events/year) events were recorded, respectively. At 10-year patients treated with β-blockers had a better outcome (HR 0.447, p < 0.01) with no effects as regards β1selective drugs (53%) vs. β1-β2 blockers (47%). Survival improved in parallel with β-blocker dose increase (HR 0.296, 0.496, 0.490 for the high, medium, and low dose vs. no β-blockers, p < 0.0001).CONCLUSION: HF patients with AF taking a β-blocker have a better outcome (with a survival improvement in parallel with daily dose but no differences as regards β1 selectivity) but this does not mean that β-blockers improve outcomes in these patients as we cannot control for all the potential confounders associated with β-blocker use.

U2 - 10.1016/j.ijcard.2018.08.012

DO - 10.1016/j.ijcard.2018.08.012

M3 - Article

VL - 273

SP - 141

EP - 146

JO - International Journal of Cardiology

JF - International Journal of Cardiology

SN - 0167-5273

ER -