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Frequency of Utilization of Beta Blockers in Patients With Heart Failure and Depression and Their Effect on Mortality.
- Source :
-
The American journal of cardiology [Am J Cardiol] 2019 Sep 01; Vol. 124 (5), pp. 746-750. Date of Electronic Publication: 2019 Jun 06. - Publication Year :
- 2019
-
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.<br /> (Copyright © 2019 Elsevier Inc. All rights reserved.)
- 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
Subjects
Details
- Language :
- English
- ISSN :
- 1879-1913
- Volume :
- 124
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- The American journal of cardiology
- Publication Type :
- Academic Journal
- Accession number :
- 31277789
- Full Text :
- https://doi.org/10.1016/j.amjcard.2019.05.054