European Heart Journal Advance Access originally published online on September 23, 2005
European Heart Journal 2005 26(24):2689-2697; doi:10.1093/eurheartj/ehi473
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Beta-blocker treatment of chronic systolic heart failure improves prognosis even in patients meeting one or more exclusion criteria of the MERIT-HF study
1Institut für Herzinfarktforschung, Herzzentrum Ludwigshafen, Bremserstr. 79, D-67063 Ludwigshafen am Rhein, Germany
2Medizinische Klinik III, Universität Heidelberg, Heidelberg, Germany
3Abt. Kardiologie, Theresienkrankenhaus, Mannheim, Germany
Received 23 February 2005; revised 28 July 2005; accepted 4 August 2005; online publish-ahead-of-print 23 September 2005.
* Corresponding author. Tel: +49 621 5032850; fax: +49 621 5032899. E-mail address: rauchb{at}klilu.de
Aims Improved prognosis of patients with chronic systolic heart failure by treatment with beta-blockers has been shown in several randomized controlled multicentre trials. However, in clinical practice only a part of heart failure patients meet the inclusion criteria of these trials. The present study evaluates whether reduction of mortality by beta-blockers also can be achieved in patients presenting one or more exclusion criteria of the MERIT-HF trial.
Methods and results From the Ludwigshafen Heart Failure Registry 675 patients with chronic systolic heart failure consecutively enrolled between January 1995 and June 2004 were divided in two groups either meeting the inclusion criteria of the MERIT-HF trial (‘trial patients’: n=278, 60% treated with beta-blockers) or not (‘non-trial patients’: n=397; 51% treated with beta-blockers). The distribution of the MERIT-HF exclusion criteria in the group of ‘non-trial patients’ was as follows: acute myocardial infarction 9.6%; systolic blood pressure <100 mmHg 7.5%; chronic obstructive lung disease 33.2%; other serious diseases potentially limiting prognosis 16.9%; acutely performed or planned ICD, bypass surgery, PCI, heart transplantation: 17.1, 15.9, 7.8, and 4.8%, respectively. Median follow-up was 31.3 months (upper/lower quartile 16.3/50.0 months). All-cause mortality was significantly reduced by beta-blocker treatment not only in ‘trial patients’ (adjusted hazard ratio 0.57, 95% CI 0.38–0.86) but also in ‘non-trial patients’ (adjusted hazard ratio 0.72, 95% CI 0.53–0.97).
Conclusion In clinical practice only the smaller part of the population to be treated for chronic systolic heart failure meets the inclusion criteria of the MERIT-HF study. However, beta-blocker treatment is associated with a significantly reduced long-term mortality even in patients meeting one or more exclusion criteria of the MERIT-HF study.
Key Words: Chronic systolic heart failure • Beta-blocker • Prognosis • MERIT-HF study • Registry
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