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Background: Alpha adrenergic blocking agents (AB) were shown to increase the risk of heart failure (HF) in the ALLHAT study, yet these agents are commonly used to treat prostatic hypertrophy in men, including those with or at risk for HF. We evaluated whether use of AB in patients admitted for HF was associated with readmission for HF or death.
Methods: We created a cohort of patients discharged from a Veterans Affairs hospital between January 2002 and September 2015 with a primary diagnosis of HF and ascertained AB use at discharge. Patients were propensity score-matched on baseline characteristics. Outcomes were time to first readmission for HF or death at 2 years. The effects of AB dose/type and beta blocker (BB) use were also evaluated.
Results: Of 169,911 HF patients, 28% were prescribed AB, and 38,991 matched pairs resulted. In the propensity score-matched cohort using AB non-users as reference, there was a lower rate of HF readmission (38% vs 40% at 2 years, HR 0.94, 95% CI 0.92-0.97, p<0.0001) and death (40 vs 44%, HR 0.91, 95% CI 0.89-0.92, p<0.0001). In a sub-analysis of AB treated patients, those treated with higher AB doses had no difference in HF readmission (HR 0.98, 95% CI 0.94-1.0, p=0.48) but a lower incidence of death (HR 0.91, 95% CI 0.88-0.94, p<0.0001), as were patients treated with non-selective versus selective (non-vasoactive) AB agents (HR 0.97, 95% CI 0.94-1.0, p=0.07; for death HR 0.85, 95% CI 0.83-0.87, p<0.0001). AB treatment was associated with less HF in both BB treated (HR 0.94, 95% CI 0.92-0.96, p<0.0001) and BB untreated patients (HR 0.95, 95% CI 0.9-1.0, p=0.03; p=0.15 for AB/BB interaction). Death was lower in AB in BB treated (HF 0.90, 95% CI 0.88-0.91, p<.0001) and BB untreated (HR 0.92, 95% CI 0.88-0.95, p<0.0001, p=0.35 for interaction) patients.
Conclusions: Treatment of HF patients with AB was associated with a small decrease in rates of HF readmission and death, with higher doses and nonselective AB agents associated with greater mortality reduction, and regardless of background BB use. ABs may be used safely in HF patients where clinically indicated. The finding of improved outcomes with AB treatment may warrant further study.
Moderated Poster Contributions
Heart Failure and Cardiomyopathies Moderated Poster Theater, Poster Hall, Hall C
Saturday, March 18, 2017, 10:00 a.m.-10:10 a.m.
Session Title: The Old and the New: Impact of Heart Failure Drug Therapies
Abstract Category: 14. Heart Failure and Cardiomyopathies: Therapy
Presentation Number: 1216M-05
- 2017 American College of Cardiology Foundation