Association Between Use of Statins and Outcomes in Heart Failure With Reduced Ejection Fraction: A Prospective Propensity Score Matched Cohort Study of 21,864 Patients in the Swedish Heart Failure Registry.

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Association Between Use of Statins and Outcomes in Heart Failure With Reduced Ejection Fraction: A Prospective Propensity Score Matched Cohort Study of 21,864 Patients in the Swedish Heart Failure Registry.

Circ Heart Fail. 2015 Jan 9;

Authors: Alehagen U, Benson L, Edner M, Dahlström U, Lund LH

Abstract
BACKGROUND: -In heart failure with reduced ejection fraction (HFREF), randomized trials of statins did not demonstrate improved outcomes. However, randomized trials may not always be generalizable. The aim was to determine whether statins are associated with improved outcomes in an un-selected nationwide population of patients with HFREF overall and in relation to ischemic heart disease (IHD).
METHODS AND RESULTS: -In the Swedish Heart Failure Registry, 21,864 patients with HFREF (age±SD 72±12 years, 29% women), of whom 10,345 (47%) were treated with statins, were studied. Propensity scores for statin use were derived from 42 baseline variables. The associations between statin use and outcomes were assessed with Cox regressions in a population matched 1:1 based on propensity score and age and in the overall population with adjustment for propensity score and age. The primary outcome was all-cause mortality; secondary outcomes were: cardiovascular mortality; HF hospitalization; and combined all-cause mortality or cardiovascular hospitalization. Survival at 1 year in the matched population was 83% for statin-treated vs. 79% for untreated patients, hazard ratio (HR), 0.81 (95% CI, 0.76-0.86, p<0.001). In the un-matched population, 1-year survival was 85% for statin-treated vs. 79% for untreated patients, HR after adjustment for propensity score and age, 0.84 (95% CI, 0.80-0.89, p<0.001). No examined baseline variables interacted with statin use except for IHD (p=0.001), with a HR of 0.76 (95% CI, 0.70-0.82, p<0.001) with and 0.95 (95% CI, 0.85-1.07, p=0.430 without IHD. Statin use was also associated with reduced risk for all 3 secondary outcomes.
CONCLUSIONS: -In an un-selected nationwide population of patients with HFREF, statins were associated with improved outcomes, specifically in the presence of IHD. This contrasts with previous randomized controlled trials (RCTs). Additional RCTs with more generalized inclusion or focused on IHD may be warranted.

PMID: 25575580 [PubMed - as supplied by publisher]

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