Are beta2-agonists responsible for increased mortality in heart failure?

Hdl Handle:
http://hdl.handle.net/10147/207501
Title:
Are beta2-agonists responsible for increased mortality in heart failure?
Authors:
Bermingham, Margaret; O'Callaghan, Eleanor; Dawkins, Ian; Miwa, Saki; Samsudin, Shazzarina; McDonald, Kenneth; Ledwidge, Mark
Affiliation:
Heart Failure Unit, St Vincent's University Hospital, Elm Park, Dublin 4,, Ireland.
Citation:
Eur J Heart Fail. 2011 Aug;13(8):885-91.
Journal:
European journal of heart failure
Issue Date:
1-Feb-2012
URI:
http://hdl.handle.net/10147/207501
DOI:
10.1093/eurjhf/hfr063
PubMed ID:
21791542
Abstract:
AIMS: Previous large-scale, retrospective studies have shown increased mortality in heart failure (HF) patients using beta2-agonists (B2As). We further examined the relationship between B2A use and mortality in a well-characterized population by adjusting for natriuretic peptide levels as a measure of HF severity. METHODS AND RESULTS: This was a retrospective cohort study of patients attending an HF Disease Management Programme with mean follow-up of 2.9 +/- 2.4 years. Chart review confirmed B2A use, dose and duration of use, and documented pulmonary function evaluation. The primary endpoint was the effect of B2A use compared with no B2A use on mortality using unadjusted and adjusted Kaplan-Meier survival curves. Data were available for 1294 patients (age 70.6 +/- 11.5 years) of whom 64% were male and 22.2% were taking B2As. beta2-Agonist users were older, more likely to be male, to have smoked, to have chronic obstructive pulmonary disease (COPD) and asthma, and less likely to take beta-blockers. Multivariable associates of mortality included: B-type natriuretic peptide (BNP), coronary artery disease, age, and beta-blocker use. Unadjusted mortality rates for B2A users were found to be significantly higher than non-B2A users [hazard ratio (HR) 1.304, 95% confidence interval (CI) 1.030-1.652, P= 0.028]. However, when adjusted for age, sex, medication, co-morbidity, smoking, COPD, and BNP differences, overall mortality rates were similar [HR 1.043, 95% CI (0.771-1.412), P= 0.783]. CONCLUSION: Unlike previous reports, this retrospective evaluation of B2A therapy in HF patients shows no relationship with long-term mortality when adjusted for population differences including BNP. Large, prospective studies are required to define the risk/benefit ratio of B2As in patients with heart failure.
Language:
eng
MeSH:
Administration, Inhalation; Adrenergic beta-2 Receptor Agonists/administration & dosage/*adverse effects; Aged; Aged, 80 and over; Cohort Studies; Female; Heart Failure/complications/*mortality; Humans; Lung Diseases, Obstructive/complications/*drug therapy; Male; Retrospective Studies
ISSN:
1879-0844 (Electronic); 1388-9842 (Linking)

Full metadata record

DC FieldValue Language
dc.contributor.authorBermingham, Margareten_GB
dc.contributor.authorO'Callaghan, Eleanoren_GB
dc.contributor.authorDawkins, Ianen_GB
dc.contributor.authorMiwa, Sakien_GB
dc.contributor.authorSamsudin, Shazzarinaen_GB
dc.contributor.authorMcDonald, Kennethen_GB
dc.contributor.authorLedwidge, Marken_GB
dc.date.accessioned2012-02-01T10:29:37Z-
dc.date.available2012-02-01T10:29:37Z-
dc.date.issued2012-02-01T10:29:37Z-
dc.identifier.citationEur J Heart Fail. 2011 Aug;13(8):885-91.en_GB
dc.identifier.issn1879-0844 (Electronic)en_GB
dc.identifier.issn1388-9842 (Linking)en_GB
dc.identifier.pmid21791542en_GB
dc.identifier.doi10.1093/eurjhf/hfr063en_GB
dc.identifier.urihttp://hdl.handle.net/10147/207501-
dc.description.abstractAIMS: Previous large-scale, retrospective studies have shown increased mortality in heart failure (HF) patients using beta2-agonists (B2As). We further examined the relationship between B2A use and mortality in a well-characterized population by adjusting for natriuretic peptide levels as a measure of HF severity. METHODS AND RESULTS: This was a retrospective cohort study of patients attending an HF Disease Management Programme with mean follow-up of 2.9 +/- 2.4 years. Chart review confirmed B2A use, dose and duration of use, and documented pulmonary function evaluation. The primary endpoint was the effect of B2A use compared with no B2A use on mortality using unadjusted and adjusted Kaplan-Meier survival curves. Data were available for 1294 patients (age 70.6 +/- 11.5 years) of whom 64% were male and 22.2% were taking B2As. beta2-Agonist users were older, more likely to be male, to have smoked, to have chronic obstructive pulmonary disease (COPD) and asthma, and less likely to take beta-blockers. Multivariable associates of mortality included: B-type natriuretic peptide (BNP), coronary artery disease, age, and beta-blocker use. Unadjusted mortality rates for B2A users were found to be significantly higher than non-B2A users [hazard ratio (HR) 1.304, 95% confidence interval (CI) 1.030-1.652, P= 0.028]. However, when adjusted for age, sex, medication, co-morbidity, smoking, COPD, and BNP differences, overall mortality rates were similar [HR 1.043, 95% CI (0.771-1.412), P= 0.783]. CONCLUSION: Unlike previous reports, this retrospective evaluation of B2A therapy in HF patients shows no relationship with long-term mortality when adjusted for population differences including BNP. Large, prospective studies are required to define the risk/benefit ratio of B2As in patients with heart failure.en_GB
dc.language.isoengen_GB
dc.subject.meshAdministration, Inhalationen_GB
dc.subject.meshAdrenergic beta-2 Receptor Agonists/administration & dosage/*adverse effectsen_GB
dc.subject.meshAgeden_GB
dc.subject.meshAged, 80 and overen_GB
dc.subject.meshCohort Studiesen_GB
dc.subject.meshFemaleen_GB
dc.subject.meshHeart Failure/complications/*mortalityen_GB
dc.subject.meshHumansen_GB
dc.subject.meshLung Diseases, Obstructive/complications/*drug therapyen_GB
dc.subject.meshMaleen_GB
dc.subject.meshRetrospective Studiesen_GB
dc.titleAre beta2-agonists responsible for increased mortality in heart failure?en_GB
dc.contributor.departmentHeart Failure Unit, St Vincent's University Hospital, Elm Park, Dublin 4,, Ireland.en_GB
dc.identifier.journalEuropean journal of heart failureen_GB
dc.description.provinceLeinster-

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