Effect of Statins, Angiotensin-Converting Enzyme Inhibitors, and Beta Blockers on Survival in Patients ≥65 Years of Age With Heart Failure and Preserved Left Ventricular Systolic Function

• Published in: The American journal of cardiology 2008-01, Vol.101 (2), p.217-222
• Main Authors: Shah, Rahman, MD, Wang, Yung, PhD, Foody, JoAnne M., MD
• Format: Article
• Language: English
• Subjects: ACE inhibitors; Adrenergic beta-Antagonists - administration & dosage; Adrenergic beta-Antagonists - therapeutic use; Aged; Aged, 80 and over; Angiotensin-Converting Enzyme Inhibitors - administration & dosage; Angiotensin-Converting Enzyme Inhibitors - therapeutic use; Beta blockers; Biological and medical sciences; Cardiology; Cardiology. Vascular system; Cardiovascular; Cholesterol; Databases, Factual - statistics & numerical data; Diagnosis-Related Groups - statistics & numerical data; Drug therapy; Drug Therapy, Combination; Female; Heart; Heart failure; Heart Failure - drug therapy; Heart Failure - mortality; Heart Failure - pathology; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; Hospitalization - statistics & numerical data; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - administration & dosage; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; Male; Medicaid; Medical sciences; Medicare; Mortality; Proportional Hazards Models; Survival Analysis; Systole; United States - epidemiology; Ventricular Function, Left
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2007.08.050

About half of all patients with heart failure (HF) have preserved left ventricular systolic function. Statins, angiotensin-converting enzyme inhibitors, and β blockers have been shown to improve survival in patients with HF and low ejection fraction. However, no large national study has investigated these agents in patients with HF and preserved left ventricular ejection fraction. We evaluated a nationwide sample of 13,533 eligible Medicare beneficiaries aged ≥65 years who were hospitalized with a primary discharge diagnosis of HF and had chart documentation of preserved left ventricular ejection fraction between April 1998 and March 1999 or between July 2000 and June 2001. In Cox proportional hazard model accounting for demographic profile, clinical characteristics, treatments, physician specialty, and hospital characteristics, discharge statin therapy was associated with significant improvements in 1- and 3-year mortality (RR 0.69, 95% confidence interval [CI] 0.61 to 0.78; RR 0.73, 95% CI 0.68 to 0.79, respectively). Irrespective of total cholesterol level or coronary artery disease status, diabetes, hypertension, and age, statin therapy was associated with significant differences in mortality rates. Similarly, angiotensin-converting enzyme inhibitors were associated with better survival at 1 year (RR 0.88, 95% CI 0.82 to 0.95) and 3 years (RR 0.93, 95% CI 0.89 to 0.98). Beta-blocker therapy was associated with a nonsignificant trend at 1 year (RR 0.93, 95% CI 0.87 to 1.10) and significant survival benefits at 3 years (RR 0.92%, 95% CI 0.87 to 0.97). In conclusion, our data demonstrate that statins, angiotensin-converting enzyme inhibitors, and β blockers are associated with better short- and long-term survival in patients ≥65 years with HF and preserved left ventricular ejection fraction.