1. Frequency of Utilization of Beta Blockers in Patients With Heart Failure and Depression and Their Effect on Mortality.
- Author
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Kim C, Duan L, Phan DQ, and Lee MS
- Subjects
- Adrenergic beta-Antagonists adverse effects, Age Distribution, Aged, Cause of Death, Cohort Studies, Comorbidity, Databases, Factual, Depressive Disorder physiopathology, Echocardiography, Female, Heart Failure diagnosis, Humans, Insurance Claim Review, Kaplan-Meier Estimate, Logistic Models, Male, Middle Aged, Prevalence, Prognosis, Proportional Hazards Models, Retrospective Studies, Risk Assessment, Sex Distribution, Stroke Volume, Survival Analysis, United States, Adrenergic beta-Antagonists administration & dosage, Depressive Disorder epidemiology, Drug Utilization statistics & numerical data, Heart Failure drug therapy, Heart Failure epidemiology
- Abstract
Beta blockers reduce mortality and morbidity in patients with heart failure. Early reports linking β-blockers with depression may have limited their use in heart failure patients with co-morbid depression. Although more recent studies have challenged the association between β-blocker therapy and depression, patient and physicians remain concerned. The goal of this study is to evaluate the utilization and outcomes of β-blocker therapy in heart failure patients with depression. This is a retrospective cohort study of patients at a multicenter integrated healthcare system with a diagnosis of heart failure from 2008 to 2014. Among 6,915 patients with heart failure with left ventricular ejection fraction of <50%, 1,252 (18.1%) had a diagnosis of depression. Patients with depression were more likely to be women and had a higher prevalence of cardiovascular risk factors. Depression was associated with decreased odds of β-blocker treatment (adjusted odds ratio [OR], 0.77; 95% confidence interval [CI], 0.62 to 0.95; p = 0.016). During a mean follow-up of 2.6 years, 439 (35.1%) patients with depression died compared with 1,549 (27.4%) patients without depression. Depressed patients not treated with β-blocker had higher mortality compared with nondepressed patients (adjusted hazard ratio [HR], 1.4, 95% CI 1.09 to 1.7, p = 0.005). When treated with β-blockers, their risk of mortality was attenuated (HR 1.1, 95% CI 0.97 to 1.2, p = 0.14). In conclusion, β-blocker therapy remains underutilized in heart failure patients with depression, and its underutilization contributes to the reduced survival rate observed in this cohort., (Copyright © 2019 Elsevier Inc. All rights reserved.)
- Published
- 2019
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