Pharmaceutical Research

Patients who suffer heart failure do well if they take any beta-blocker rather than only those extensively tested for the condition

Studies have shown that patients who take certain beta-blockers for heart failure have improved survival rates. However, not all beta-blockers have been tested to treat heart failure. Three beta-blockers—carvedilol (CoReg), metoprolol succinate (Toprol XL), and bisoprolol fumarate (Zebeta)—are referred to as evidence-based beta blockers (EBBBs) because they have been tested for patients with heart failure. However, a new study finds that elderly patients prescribed either EBBBs or non-EBBBs after hospitalizations for heart failure have similar survival rates.

Judith M. Kramer, M.D., M.S., of Duke University, and her colleagues found that patients hospitalized with heart failure who took EBBBs had a 24-percent mortality rate 1 year after their hospitalizations. Those who took non-EBBBs had a 23-percent mortality rate. In contrast, patients who received no beta-blockers had a 28-percent mortality rate. Nearly 60 percent of patients received no beta blockers. The authors note that physicians who fail to prescribe beta blockers and patients who fail to take them may contribute to higher mortality rates from heart failure.

In the year following their hospitalizations for heart failure, patients who took EBBBs were rehospitalized more often than patients taking non-EBBBs or no beta blockers. These rehospitalizations may have occurred because the patients had other risks for rehospitalization or had physicians who provided better quality care and readmitted the patients to monitor them, the authors suggest. Because patients were not randomly assigned to receive EBBBs or non-EBBBs, the authors caution that the findings need to be replicated.

This study of 11,959 patients eligible for Medicare and Medicaid in North Carolina was funded in part by a grant from the Agency for Healthcare Research and Quality (HS10548) to the Duke Center for Education and Research on Therapeutics (CERT). For more information on the CERTs program, visit http://certs.hhs.gov.

See "Comparative effectiveness of beta-blockers in elderly patients with heart failure," by Dr. Kramer, Lesley H. Curtis, Ph.D., Carla S. Dupree, M.D., Ph.D., and others in the December 8, 2008, Archives of Internal Medicine 168(22), pp. 2422-2428.

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