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Effect of beta-blocker therapy on survival in patients with severe aortic regurgitation results from a cohort of 756 patients.
Journal of the American College of Cardiology 2009 July 29
OBJECTIVES: We sought to investigate the effect of beta-blocker (BB) therapy on survival in patients with severe aortic regurgitation (AR).
BACKGROUND: Beta-blockers are thought to be contraindicated in patients with AR because a slower heart rate increases the duration of diastole during which AR occurs. But AR also causes neuroendocrine activation similar to a heart failure state for which BBs are potentially beneficial.
METHODS: This is an observational study. Our echocardiographic database was screened for patients with severe AR. Detailed chart reviews were performed for clinical, demographic, and therapeutic data. Mortality data were obtained from the Social Security Death Index and analyzed as a function of BB therapy.
RESULTS: Three hundred fifty-five (47%) of the 756 patients with severe AR were on a BB; mean age 61 +/- 18 years and ejection fraction was 54 +/- 19%. Over a mean follow-up of 4.5 years, BB therapy was associated with a higher survival rate (1- and 5-year survival rates of 90% and 70%, respectively) compared with those without (1- and 5-year survival rates of 75% and 55%, respectively) (p = 0.0009). The Cox regression model showed that BB therapy was an independent predictor of better survival after adjusting for age, sex, heart rate, hypertension, coronary artery disease, diabetes mellitus, heart failure, renal insufficiency, ejection fraction, and aortic valve replacement (hazard ratio: 0.74, 95% confidence interval: 0.58 to 0.93, p = 0.01). The survival benefit of BB therapy was further supported by propensity score analysis.
CONCLUSIONS: This observational study strongly suggests that BB therapy is associated with a survival benefit in patients with severe AR.
BACKGROUND: Beta-blockers are thought to be contraindicated in patients with AR because a slower heart rate increases the duration of diastole during which AR occurs. But AR also causes neuroendocrine activation similar to a heart failure state for which BBs are potentially beneficial.
METHODS: This is an observational study. Our echocardiographic database was screened for patients with severe AR. Detailed chart reviews were performed for clinical, demographic, and therapeutic data. Mortality data were obtained from the Social Security Death Index and analyzed as a function of BB therapy.
RESULTS: Three hundred fifty-five (47%) of the 756 patients with severe AR were on a BB; mean age 61 +/- 18 years and ejection fraction was 54 +/- 19%. Over a mean follow-up of 4.5 years, BB therapy was associated with a higher survival rate (1- and 5-year survival rates of 90% and 70%, respectively) compared with those without (1- and 5-year survival rates of 75% and 55%, respectively) (p = 0.0009). The Cox regression model showed that BB therapy was an independent predictor of better survival after adjusting for age, sex, heart rate, hypertension, coronary artery disease, diabetes mellitus, heart failure, renal insufficiency, ejection fraction, and aortic valve replacement (hazard ratio: 0.74, 95% confidence interval: 0.58 to 0.93, p = 0.01). The survival benefit of BB therapy was further supported by propensity score analysis.
CONCLUSIONS: This observational study strongly suggests that BB therapy is associated with a survival benefit in patients with severe AR.
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