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Calcium-Channel Blockers and Outcomes in Older Patients With Heart Failure and Preserved Ejection Fraction.
Circ Heart Fail. 2014 Oct 8;
Authors: Patel K, Fonarow GC, Ahmed M, Morgan C, Kilgore M, Love TE, Deedwania P, Aronow WS, Anker SD, Ahmed A
Abstract
BACKGROUND: -Little is known about associations of calcium channel blockers (CCBs) with outcomes in patients with heart failure and preserved ejection fraction (HFpEF).
METHODS AND RESULTS: -Of the 10,570 hospitalized HFpEF patients, ≥65 years, EF ≥40%, in the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF; 2003-2004), linked to Medicare data (through December 31, 2008), 7514 had no prior history of CCB use. Of these, 815 (11%) patients received new discharge prescriptions for CCBs. Propensity scores for CCB initiation, calculated for each of the 7514 patients, were used to assemble a matched cohort of 1620 (810 pairs) patients (mean age, 80 years; mean EF, 56%; 65% women; 10% African American) receiving and not receiving CCBs, balanced on 114 baseline characteristics. The primary composite endpoint of all-cause mortality or HF hospitalization occurred in 82% and 81% of patients receiving and not receiving CCBs (hazard ratio {HR} for CCBs, 1.03; 95% confidence interval {CI}, 0.92-1.14). HRs (95% CIs) for all-cause mortality, HF hospitalization and all-cause hospitalization were 1.05 (0.94-1.18), 1.05 (0.91-1.21), and 1.03 (0.93-1.14), respectively. Similar associations were observed when we categorized patients into those receiving amlodipine and non-amlodipine CCBs. Among 7514 pre-match patients, multivariable-adjusted and propensity-adjusted HRs (95% CI) for primary composite endpoint were 1.03 (0.95-1.12) and 1.02 (0.94-1.11), respectively.
CONCLUSIONS: -In hospitalized older HFpEF patients, new discharge prescriptions for CCBs had no associations with composite or individual endpoints of mortality or HF hospitalization, regardless of the class of CCBs.
PMID: 25296862 [PubMed - as supplied by publisher]