Imperial College London
Alternate

ProfessorPeterCollins

Faculty of Medicine, National Heart & Lung Institute

Professor of Clinical Cardiology
 
 
 
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Contact

 

+44 (0)20 7351 8112peter.collins

 
 
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Location

 

Chelsea WingRoyal Brompton Campus

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Summary

 

Publications

Citation

BibTex format

@article{Kotecha:2016:10.1136/bmj.i1855,
author = {Kotecha, D and Manzano, L and Krum, H and Rosano, G and Holmes, J and Altman, DG and Collins, PD and Packer, M and Coats, AJS and Cleland, JGF and Kirchhof, P and von, Lueder TG and Rigby, AS and Andersson, B and Lip, G and van, Veldhuisen D and Shibata, M and Wedel, H and Böhm, M and Flather, MD and Beta-Blockers, in Heart Failure Collaborative Group},
doi = {10.1136/bmj.i1855},
journal = {BMJ},
title = {Effect of age and gender on efficacy and tolerability of beta-blockers in heart failure with reduced ejection fraction: An individual patient data meta-analysis},
url = {http://dx.doi.org/10.1136/bmj.i1855},
volume = {353},
year = {2016}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - Background:  Beta-blockers are recommended in heart failure patients with reduced ejection fraction (HFrEF) and sinus rhythm, but prescription rates are consistently lower in older patients and women.    Objectives:  We sought to determine the efficacy and tolerability of beta-blockers in a broad age-range of adult women and men with HFrEF by pooling individual patient data (IPD) from placebo-controlled randomized trials.Methods:  The study was a prospectively designed IPD meta-analysis of patients aged 40-85 years in sinus rhythm at baseline, with left-ventricular ejection fraction <0.45.  The primary outcome was all-cause mortality and major secondary outcome heart failure hospitalization.  Analysis was by intention to treat using an adjusted one-stage Cox proportional hazards model.  Registration: PROSPERO CRD42014010012; Clinicaltrials.gov NCT00832442.Results:  13,833 patients were included from 11 trials, with median age 64 years and 24% women.  Beta-blockers were effective in reducing mortality versus placebo across all ages: Quartile 1 (median age 50) hazard ratio (HR) 0.66 (95% CI 0.53 to 0.83); Quartile 2 (median 60) HR 0.71 (0.58 to 0.87); Quartile 3 (median 68) HR 0.65 (0.53 to 0.78); Quartile 4 (median 75) HR 0.77 (0.64 to 0.92).  There was no significant interaction when age was modelled continuously (p=0.10) and the absolute mortality reduction was 4.3% over a median follow-up of 1.3 years (number needed to treat=23).  Heart failure hospitalization was significantly reduced by beta-blockers, although this effect was attenuated at older age (interaction p=0.05).  There was no evidence of an interaction between treatment effect and gender in any age group.  Drug discontinuation was similar regardless of treatment allocation, age or gender (14.4% beta-blockers, 15.6% placebo).Conclusion:  Irrespective of age or gender, patients with HFrEF in sinus rhythm should receive beta-blockers to reduce the risk of death and hospitalization.
AU  - Kotecha,D
AU  - Manzano,L
AU  - Krum,H
AU  - Rosano,G
AU  - Holmes,J
AU  - Altman,DG
AU  - Collins,PD
AU  - Packer,M
AU  - Coats,AJS
AU  - Cleland,JGF
AU  - Kirchhof,P
AU  - von,Lueder TG
AU  - Rigby,AS
AU  - Andersson,B
AU  - Lip,G
AU  - van,Veldhuisen D
AU  - Shibata,M
AU  - Wedel,H
AU  - Böhm,M
AU  - Flather,MD
AU  - Beta-Blockers,in Heart Failure Collaborative Group
DO  - 10.1136/bmj.i1855
PY  - 2016///
SN  - 0959-8138
TI  - Effect of age and gender on efficacy and tolerability of beta-blockers in heart failure with reduced ejection fraction: An individual patient data meta-analysis
T2  - BMJ
UR  - http://dx.doi.org/10.1136/bmj.i1855
UR  - http://hdl.handle.net/10044/1/31037
VL  - 353
ER  -
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