@article {7983, title = {Association of Alcohol Consumption After Development of Heart Failure With Survival Among Older Adults in the Cardiovascular Health Study.}, journal = {JAMA Netw Open}, volume = {1}, year = {2018}, month = {2018 Dec 07}, pages = {e186383}, abstract = {

Importance: More than 1 million older adults develop heart failure annually. The association of alcohol consumption with survival among these individuals after diagnosis is unknown.

Objective: To determine whether alcohol use is associated with increased survival among older adults with incident heart failure.

Design, Setting, and Participants: This prospective cohort study included 5888 community-dwelling adults aged 65 years or older who were recruited to participate in the Cardiovascular Health Study between June 12, 1989, and June 1993, from 4 US sites. Of the total participants, 393 individuals had a new diagnosis of heart failure within the first 9 years of follow-up through June 2013. The study analysis was performed between January 19, 2016, and September 22, 2016.

Exposures: Alcohol consumption was divided into 4 categories: abstainers (never drinkers), former drinkers, 7 or fewer alcoholic drinks per week, and more than 7 drinks per week.

Primary Outcomes and Measures: Participant survival after the diagnosis of incident heart failure.

Results: Among the 393 adults diagnosed with incident heart failure, 213 (54.2\%) were female, 339 (86.3\%) were white, and the mean (SD) age was 78.7 (6.0) years. Alcohol consumption after diagnosis was reported in 129 (32.8\%) of the participants. Across alcohol consumption categories of long-term abstainers, former drinkers, consumers of 1-7 drinks weekly and consumers of more than 7 drinks weekly, the percentage of men (32.1\%, 49.0\%, 58.0\%, and 82.4\%, respectively; P < .001 for trend), white individuals (78.0\%, 92.7\%, 92.0\%, and 94.1\%, respectively, P <. 001 for trend), and high-income participants (22.0\%, 43.8\%, 47.3\%, and 64.7\%, respectively; P < .001 for trend) increased with increasing alcohol consumption. Across the 4 categories, participants who consumed more alcohol had more years of education (mean, 12 years [interquartile range (IQR), 8.0-10.0 years], 12 years [IQR, 11.0-14.0 years], 13 years [IQR, 12.0-15.0 years], and 13 years [IQR, 12.0-14.0 years]; P < .001 for trend). Diabetes was less common across the alcohol consumption categories (32.1\%, 26.0\%, 22.3\%, and 5.9\%, respectively; P = .01 for trend). Across alcohol consumption categories, there were fewer never smokers (58.3\%, 44.8\%, 35.7\%, and 29.4\%, respectively; P < .001 for trend) and more former smokers (34.5\%, 38.5\%, 50.0\%, and 52.9\%, respectively; P = .006 for trend). After controlling for other factors, consumption of 7 or fewer alcoholic drinks per week was associated with additional mean survival of 383 days (95\% CI, 17-748 days; P = .04) compared with abstinence from alcohol. Although the robustness was limited by the small number of individuals who consumed more than 7 drinks per week, a significant inverted U-shaped association between alcohol consumption and survival was observed. Multivariable model estimates of mean time from heart failure diagnosis to death were 2640 days (95\% CI, 1967-3313 days) for never drinkers, 3046 days (95\% CI, 2372-3719 days) for consumers of 0 to 7 drinks per week, and 2806 (95\% CI, 1879-3734 days) for consumers of more than 7 drinks per week (P = .02). Consumption of 10 drinks per week was associated with the longest survival, a mean of 3381 days (95\% CI, 2806-3956 days) after heart failure diagnosis.

Conclusions and Relevance: These findings suggest that limited alcohol consumption among older adults with incident heart failure is associated with survival benefit compared with long-term abstinence. These findings suggest that older adults who develop heart failure may not need to abstain from moderate levels of alcohol consumption.

}, issn = {2574-3805}, doi = {10.1001/jamanetworkopen.2018.6383}, author = {Sadhu, Justin S and Novak, Eric and Mukamal, Kenneth J and Kizer, Jorge R and Psaty, Bruce M and Stein, Phyllis K and Brown, David L} }