02971nas a2200373 4500008004100000022001400041245011900055210006900174260001300243300001000256490000800266520185400274653003202128653000902160653004402169653004502213653001902258653001702277653003002294653001102324653001802335653001102353653000902364653002602373653001502399100002302414700002102437700001902458700002202477700002402499700001902523700002002542856003502562 2004 eng d a1097-674400aTime trends in the use of beta-blockers and other pharmacotherapies in older adults with congestive heart failure.0 aTime trends in the use of betablockers and other pharmacotherapi c2004 Oct a710-70 v1483 a

BACKGROUND: Evidence supporting pharmacotherapy of congestive heart failure (CHF) has grown substantially over the past decade and includes large, placebo-controlled trials with mortality end points. We describe beta-blocker and other medication temporal treatment trends of CHF in the Cardiovascular Health Study, a community-based cohort study of 5888 adults > or =65 years of age.

METHODS: Prescription medication data were collected from hospital discharge summaries for incident CHF events and at in-study annual clinic visits for prevalent CHF cases from 1989 to 2000. Change in use of agents over time was estimated by using generalized estimating equations while adjusting for potential confounding factors of age, sex, race, and cardiovascular and pulmonary comorbidities.

RESULTS: Among 1033 incident CHF events, beta-blocker use after diagnosis increased an average of 2.4 percentage points annually (95% CI, 1.5 to 3.4 points) from 1989 to 2000. The increasing trend was consistent throughout follow-up. Among participants with coronary disease and/or hypertension and among those with low ejection fractions (<45%), beta-blocker use remained flat from 1989 to 1994 and increased 4.7 points annually (2.5 to 6.9) and 10.0 points annually (6.1 to 13.8), respectively, from 1995 to 2000. Among participants without coronary disease or hypertension, there was no overall increase in use. Use of renin-angiotensin system inhibitors increased 2.3 points annually (1.0 to 3.5), digoxin use decreased 2.4 points annually (-3.6 to -1.1), and loop diuretic use remained flat between 1989 and 2000. In general, treatment trends were similar for prevalent CHF.

CONCLUSIONS: Treatment of CHF has changed gradually in the 1990s and may in part reflect the influence of CHF clinical trial evidence.

10aAdrenergic beta-Antagonists10aAged10aAngiotensin II Type 1 Receptor Blockers10aAngiotensin-Converting Enzyme Inhibitors10aCohort Studies10aDrug Therapy10aDrug Therapy, Combination10aFemale10aHeart Failure10aHumans10aMale10aMultivariate Analysis10aPrevalence1 aSmith, Nicholas, L1 aChan, Jeannie, D1 aRea, Thomas, D1 aWiggins, Kerri, L1 aGottdiener, John, S1 aLumley, Thomas1 aPsaty, Bruce, M uhttps://chs-nhlbi.org/node/80702860nas a2200361 4500008004100000022001400041245013800055210006900193260001300262300001100275490000800286520181600294653003202110653001602142653000902158653002202167653001102189653002202200653001802222653001102240653000902251100002102260700001902281700002302300700002102323700002302344700001902367700001802386700002102404700001802425700002002443856003502463 2005 eng d a1097-674400aAssociation of beta-blocker use with mortality among patients with congestive heart failure in the Cardiovascular Health Study (CHS).0 aAssociation of betablocker use with mortality among patients wit c2005 Sep a464-700 v1503 a

BACKGROUND: In clinical trials, beta-blocker therapy reduces all-cause mortality among people with congestive heart failure (CHF) characterized by depressed systolic function, but few trials included large numbers of elderly participants. This study assessed the association between beta-blocker therapy and mortality among community-dwelling older adults with CHF.

METHODS: The Cardiovascular Health Study (CHS) is a longitudinal, population-based study of adults aged > or = 65 years. Recruitment began in 1989 with follow-up extending through June 2000 or death. Cox proportional hazard regression models were used to assess the association between beta-blocker therapy and all-cause mortality among 950 participants who developed new-onset CHF.

RESULTS: beta-Blocker users (n = 157) were more likely than nonusers (n = 793) to have treated hypertension, clinical coronary artery disease, and valvular disease at the time of CHF diagnosis. Death occurred in 67 users and 446 nonusers during a median follow-up of 2.3 years. Compared with nonuse, use of beta-blockers was associated with a multivariable adjusted hazard ratio (HR) of 0.74 (95% CI 0.56-0.98) for all-cause mortality. Among the 520 participants who had left ventricular ejection fraction assessed within 90 days after CHF diagnosis, the risk for all cause mortality associated with beta-blocker use did not differ significantly between those with ejection fraction of < 40% and those with ejection fraction of > or = 40% (HR 0.56, 95% CI 0.27-1.13; HR 0.82, 95% CI 0.56-1.22, respectively; interaction P = .34).

CONCLUSIONS: This observational study suggests that beta-blocker treatment is associated with a reduced risk of all-cause mortality among community-dwelling older adults with CHF.

10aAdrenergic beta-Antagonists10aAge Factors10aAged10aAged, 80 and over10aFemale10aFollow-Up Studies10aHeart Failure10aHumans10aMale1 aChan, Jeannie, D1 aRea, Thomas, D1 aSmith, Nicholas, L1 aSiscovick, David1 aHeckbert, Susan, R1 aLumley, Thomas1 aChaves, Paulo1 aFurberg, Curt, D1 aKuller, Lewis1 aPsaty, Bruce, M uhttps://chs-nhlbi.org/node/856