PATTERN OF β-BLOCKER USE FOLLOWING HOSPITALIZATION OF OLDER ADULTS WITH HEART FAILURE WITH PRESERVED EJECTION FRACTION (HFPEF) FROM THE REGARDS STUDY
Abstract
Background
Older adults with heart failure with preserved ejection fraction (HFpEF) are frequently prescribed β-blockers despite limited data to show their benefit in HFpEF and some evidence that they can worsen geriatric conditions. Whether other indications for β-blocker use explain their prevalent use in HFpEF is unclear.
Methods
We examined adults aged >65 years with an adjudicated HFpEF hospitalization from the REasons for Geographic and Racial Differences in Stroke (REGARDS) study, a geographically diverse observational cohort. To determine indications for β-blockers, we identified the presence of: history of myocardial infarction (MI), arrhythmia, coronary artery disease (CAD), and hypertension.
Results
Among 316 participants with HFpEF, 67% were on a β-blocker at discharge. Among those on β-blockers, 46% had arrhythmias and 30% had MI history, both compelling indications for β-blockers, while 38% had neither of these indications. Among those with neither indication, 23% had CAD in absence of MI and 15% had just hypertension—two potential indications for β-blockers with less supportive evidence for their benefit (Figure 1). Among those taking β-blockers in the absence of arrhythmia or MI, 39% had geriatric conditions including cognitive impairment (17%), history of falls (24%), and hypoalbuminemia (35%).
Conclusion
β-blockers are commonly used in HFpEF in the absence of compelling indications, even among those with geriatric conditions which can be exacerbated by β-blockers.
Fonte: https://www.onlinejacc.org/content/73/9_Supplement_1/798