Author + information
- Received December 18, 2017
- Revision received June 18, 2018
- Accepted June 26, 2018
- Published online October 29, 2018.
- Cynthia A. Jackevicius, BScPhm, PharmD, MSca,b,c,d,e,∗ (, )@HeartRPh,
- Zunera Ghaznavi, MScf,
- Lingyun Lu, PharmD, MSca and
- Alberta L. Warner, MDf,g
- aDepartment of Pharmacy, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
- bDepartment of Pharmacy Practice and Administration, College of Pharmacy, Western University of Health Sciences, Pomona, California
- cInstitute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- dInstitute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- eDepartment of Pharmacy, University Health Network, Toronto, Ontario, Canada
- fDivision of Cardiology, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
- gDepartment of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California
- ↵∗Address for correspondence:
Dr. Jackevicius, Western University of Health Sciences, College of Pharmacy, 309 East Second Street, Pomona, California 91766.
Objectives This study evaluated whether alpha-blocker (AB) use following an admission for heart failure (HF) was associated with an increased risk of HF readmission or death.
Background ABs, found to increase the risk of HF in the ALLHAT (Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial) trial, are commonly used for prostatic hypertrophy, including in those with or at risk for HF.
Methods This propensity score–matched cohort study included patients discharged from a Veterans Affairs hospital between January 2002 and September 2015 with a primary diagnosis of HF and ascertained AB use at discharge. Cox proportional hazards models were constructed to compare time to first HF readmission and death at 2 years between groups. Secondary analyses assessed effects by AB dose and type and by beta-blocker (BB) use.
Results Of 169,911 HF patients, 47,638 (28%) were prescribed an AB. Propensity score matching resulted in 35,713 matched pairs. In the propensity score–matched cohort, AB use was associated with fewer HF readmissions (39.8% vs. 41.7% at 2 years; hazard ratio: 0.95; 95% confidence interval [CI]: 0.92 to 0.97; p < 0.0001) and death (42.8% vs. 46.5%; hazard ratio: 0.93; 95% CI: 0.91 to 0.94; p < 0.0001). Nonselective ABs had fewer deaths and HF readmissions (p < 0.0001), while higher AB doses reduced mortality (p < 0.0001). AB treatment was associated with reduced deaths in both BB-treated and untreated patients, with no increase in HF.
Conclusions Treatment of HF patients with an AB was associated not with a higher but instead with a lower rate of HF readmission and death. Higher doses and nonselective ABs were also associated with lower mortality, regardless of BB use. ABs may be used safely in HF patients where clinically indicated. The finding of improved outcomes with ABs may warrant further study.
Dr. Jackevicius is an associate editor for Circulation: Cardiovascular Quality and Outcomes. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received December 18, 2017.
- Revision received June 18, 2018.
- Accepted June 26, 2018.
- 2018 American College of Cardiology Foundation
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