No clear beneficial effects of beta-blockers for heart failure with preserved ejection fraction to improve prognostic ou
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CE - LETTER TO THE EDITOR
No clear beneficial effects of beta‑blockers for heart failure with preserved ejection fraction to improve prognostic outcomes in elderly patients with sinus rhythm Francesc Formiga1 · David Chivite1 · Sandra Díaz‑de Castellvi1 · Xavier Corbella1,2 Received: 6 May 2020 / Accepted: 3 June 2020 © Società Italiana di Medicina Interna (SIMI) 2020
Dear Editor, Heart failure (HF) with preserved ejection fraction ((HFpEF) is a prevalent clinical entity in the elderly [1]. Although beta-blockers (BB) have been shown to reduce mortality in patients with heart failure with reduced ejection fraction (HFrEF), its beneficial effect in HFpEF is still controversial [2]. In this study, we evaluated the efficacy of BB in reducing poor quality outcomes in older patients with HFpEF and sinus rhythm, after a first hospital admission due to acute HF. The principles and procedures of the study have been previously described [3]. Briefly, the investigation was performed at a 750-bed university-affiliated tertiary-care public hospital in Barcelona, Spain. We retrieved administrative data regarding all admissions within a 36 month-period with HF as the primary discharge diagnosis. Following this first selection, a thorough electronic medical record review was performed to confirm that the study population truly fulfilled clinical criteria for acute HF. Inclusion criteria for this study were age older than 70 years, HFpEF, sinus rhythm, and no history of previous hospital admission due to acute HF. All patients who had been discharged with a primary or secondary diagnosis of HF prior to the study period were excluded. The study conformed to the principles outlined in the Declaration of Helsinki and the ethics committee of the Bellvitge Hospital approved the protocol (PR2016/16). The main outcome was a composite endpoint of all-cause 1-year
mortality and readmissions from any cause. Student’s t test, with a previous Levene test, were used to compare continuous variables, while either Chi-square statistic or Fisher’s exact test were used to compare categorical or dichotomous variables respectively. Univariate and regression multivariate analyses to evaluate the odds ratio (OR) between BB use and 1 year morbid-mortality was used. For multivariate analyses, we adjusted using the variables age, sex and those found to be associated with mortality in the univariate analysis (P
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