Type of beta blocker may affect mortality after hospitalization for heart failure
Research Activities, June 2009, No. 346
Patients who are hospitalized with heart failure often receive beta blockers at discharge to reduce the risk of further heart failure. Also known as beta-adrenergic blocking agents, these medications make the heart beat more slowly and reduce blood pressure. A new study cautiously suggests that a commonly prescribed, shorter-acting beta blocker, metoprolol tartrate, may carry a higher risk of death for patients suffering from heart failure compared with atenolol.
Researchers in California and Massachusetts examined the risk of death for 11,326 patients who were discharged alive after being hospitalized for heart failure between 2001 and 2003. Nearly 8,000 of the patients received beta blockers at or after discharge, most often atenolol (39 percent), metoprolol tartrate (43 percent), or carvedilol (12 percent). The annualized death rate (per 100 person-years) in the year following hospital discharge was 20.1 for patients taking atenolol, 22.8 for patients taking metoprolol tartrate, and 17.7 for patients taking carvedilol.
Patients who did not receive or did not take beta blockers had a nearly twofold increased risk of death compared with patients who took the drugs. Patients who took metoprolol tartrate had a 16 percent higher adjusted risk of death than patients who received atenolol. In this sample, carvedilol, one of two FDA-approved beta-blockers for the treatment of heart failure, was not associated with a different adjusted death rate than atenolol, which was a frequently prescribed beta blocker during followup.
The authors recommend that further randomized studies be conducted that include a broader set of beta blockers in representative populations treated in community-based practice settings. This study was funded by the Agency for Healthcare Research and Quality through its Developing Evidence to Inform Decisions about Effectiveness program (Contract No. 290-05-0033).
See "Comparative effectiveness of different �-adrenergic antagonists on mortality among adults with heart failure in clinical practice," by Alan S. Go, M.D., Jingrong Yang, M.A., Jerry H. Gurwitz, M.D., and others in the December 8, 2008, Archives of Internal Medicine 168(22), pp. 2415-2421.