β-blocker therapy and cardiac events among patients with newly diagnosed coronary heart disease

The effectiveness of beta-blockers for preventing cardiac events has been questioned for patients who have coronary heart disease (CHD) without a prior myocardial infarction (MI). The purpose of this study was to assess the association of beta-blockers with outcomes among patients with new-onset CHD...

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Published in:	Journal of the American College of Cardiology Vol. 64; no. 3; p. 247
Main Authors:	Andersson, Charlotte, Shilane, David, Go, Alan S, Chang, Tara I, Kazi, Dhruv, Solomon, Matthew D, Boothroyd, Derek B, Hlatky, Mark A
Format:	Journal Article
Language:	English
Published:	United States 22.07.2014
Subjects:	Adrenergic beta-Antagonists - pharmacology Adrenergic beta-Antagonists - therapeutic use Aged Coronary Disease - diagnosis Coronary Disease - drug therapy Coronary Disease - mortality Electronic Health Records - trends Female Follow-Up Studies Heart Rate - drug effects Heart Rate - physiology Humans Male Middle Aged Treatment Outcome beta-blockers comparative effectiveness research outcomes research beta-adrenergic blocking agents treatment effectiveness
ISSN:	1558-3597, 1558-3597
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Abstract	The effectiveness of beta-blockers for preventing cardiac events has been questioned for patients who have coronary heart disease (CHD) without a prior myocardial infarction (MI). The purpose of this study was to assess the association of beta-blockers with outcomes among patients with new-onset CHD. We studied consecutive patients discharged after the first CHD event (acute coronary syndrome or coronary revascularization) between 2000 and 2008 in an integrated healthcare delivery system who did not use beta-blockers in the year before entry. We used time-varying Cox regression models to determine the hazard ratio (HR) associated with beta-blocker treatment and used treatment-by-covariate interaction tests (p(int)) to determine whether the association differed for patients with or without a recent MI. A total of 26,793 patients were included, 19,843 of whom initiated beta-blocker treatment within 7 days of discharge from their initial CHD event. Over an average of 3.7 years of follow-up, 6,968 patients had an MI or died. Use of beta-blockers was associated with an adjusted HR for mortality of 0.90 (95% confidence limits [CL]: 0.84 to 0.96), and an adjusted HR for death or MI of 0.92 (CL: 0.87 to 0.97). The association between beta-blockers and outcomes differed significantly between patients with and without a recent MI (HR for death: 0.85 vs. 1.02, p(int) = 0.007; and HR for death or MI: 0.87 vs. 1.03, p(int) = 0.005). Use of beta-blockers among patients with new-onset CHD was associated with a lower risk of cardiac events only among patients with a recent MI.
AbstractList	The effectiveness of beta-blockers for preventing cardiac events has been questioned for patients who have coronary heart disease (CHD) without a prior myocardial infarction (MI).BACKGROUNDThe effectiveness of beta-blockers for preventing cardiac events has been questioned for patients who have coronary heart disease (CHD) without a prior myocardial infarction (MI).The purpose of this study was to assess the association of beta-blockers with outcomes among patients with new-onset CHD.OBJECTIVESThe purpose of this study was to assess the association of beta-blockers with outcomes among patients with new-onset CHD.We studied consecutive patients discharged after the first CHD event (acute coronary syndrome or coronary revascularization) between 2000 and 2008 in an integrated healthcare delivery system who did not use beta-blockers in the year before entry. We used time-varying Cox regression models to determine the hazard ratio (HR) associated with beta-blocker treatment and used treatment-by-covariate interaction tests (p(int)) to determine whether the association differed for patients with or without a recent MI.METHODSWe studied consecutive patients discharged after the first CHD event (acute coronary syndrome or coronary revascularization) between 2000 and 2008 in an integrated healthcare delivery system who did not use beta-blockers in the year before entry. We used time-varying Cox regression models to determine the hazard ratio (HR) associated with beta-blocker treatment and used treatment-by-covariate interaction tests (p(int)) to determine whether the association differed for patients with or without a recent MI.A total of 26,793 patients were included, 19,843 of whom initiated beta-blocker treatment within 7 days of discharge from their initial CHD event. Over an average of 3.7 years of follow-up, 6,968 patients had an MI or died. Use of beta-blockers was associated with an adjusted HR for mortality of 0.90 (95% confidence limits [CL]: 0.84 to 0.96), and an adjusted HR for death or MI of 0.92 (CL: 0.87 to 0.97). The association between beta-blockers and outcomes differed significantly between patients with and without a recent MI (HR for death: 0.85 vs. 1.02, p(int) = 0.007; and HR for death or MI: 0.87 vs. 1.03, p(int) = 0.005).RESULTSA total of 26,793 patients were included, 19,843 of whom initiated beta-blocker treatment within 7 days of discharge from their initial CHD event. Over an average of 3.7 years of follow-up, 6,968 patients had an MI or died. Use of beta-blockers was associated with an adjusted HR for mortality of 0.90 (95% confidence limits [CL]: 0.84 to 0.96), and an adjusted HR for death or MI of 0.92 (CL: 0.87 to 0.97). The association between beta-blockers and outcomes differed significantly between patients with and without a recent MI (HR for death: 0.85 vs. 1.02, p(int) = 0.007; and HR for death or MI: 0.87 vs. 1.03, p(int) = 0.005).Use of beta-blockers among patients with new-onset CHD was associated with a lower risk of cardiac events only among patients with a recent MI.CONCLUSIONSUse of beta-blockers among patients with new-onset CHD was associated with a lower risk of cardiac events only among patients with a recent MI. The effectiveness of beta-blockers for preventing cardiac events has been questioned for patients who have coronary heart disease (CHD) without a prior myocardial infarction (MI). The purpose of this study was to assess the association of beta-blockers with outcomes among patients with new-onset CHD. We studied consecutive patients discharged after the first CHD event (acute coronary syndrome or coronary revascularization) between 2000 and 2008 in an integrated healthcare delivery system who did not use beta-blockers in the year before entry. We used time-varying Cox regression models to determine the hazard ratio (HR) associated with beta-blocker treatment and used treatment-by-covariate interaction tests (p(int)) to determine whether the association differed for patients with or without a recent MI. A total of 26,793 patients were included, 19,843 of whom initiated beta-blocker treatment within 7 days of discharge from their initial CHD event. Over an average of 3.7 years of follow-up, 6,968 patients had an MI or died. Use of beta-blockers was associated with an adjusted HR for mortality of 0.90 (95% confidence limits [CL]: 0.84 to 0.96), and an adjusted HR for death or MI of 0.92 (CL: 0.87 to 0.97). The association between beta-blockers and outcomes differed significantly between patients with and without a recent MI (HR for death: 0.85 vs. 1.02, p(int) = 0.007; and HR for death or MI: 0.87 vs. 1.03, p(int) = 0.005). Use of beta-blockers among patients with new-onset CHD was associated with a lower risk of cardiac events only among patients with a recent MI.
Author	Andersson, Charlotte Shilane, David Go, Alan S Boothroyd, Derek B Hlatky, Mark A Chang, Tara I Kazi, Dhruv Solomon, Matthew D
Author_xml	– sequence: 1 givenname: Charlotte surname: Andersson fullname: Andersson, Charlotte organization: Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark – sequence: 2 givenname: David surname: Shilane fullname: Shilane, David organization: Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California – sequence: 3 givenname: Alan S surname: Go fullname: Go, Alan S organization: Division of Research, Kaiser Permanente, Oakland, California – sequence: 4 givenname: Tara I surname: Chang fullname: Chang, Tara I organization: Department of Medicine, Stanford University School of Medicine, Stanford, California – sequence: 5 givenname: Dhruv surname: Kazi fullname: Kazi, Dhruv organization: Department of Medicine, University of California, San Francisco, California – sequence: 6 givenname: Matthew D surname: Solomon fullname: Solomon, Matthew D organization: Division of Research, Kaiser Permanente, Oakland, California – sequence: 7 givenname: Derek B surname: Boothroyd fullname: Boothroyd, Derek B organization: Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California – sequence: 8 givenname: Mark A surname: Hlatky fullname: Hlatky, Mark A email: hlatky@stanford.edu organization: Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California; Department of Medicine, Stanford University School of Medicine, Stanford, California. Electronic address: hlatky@stanford.edu
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SubjectTerms	Adrenergic beta-Antagonists - pharmacology Adrenergic beta-Antagonists - therapeutic use Aged Coronary Disease - diagnosis Coronary Disease - drug therapy Coronary Disease - mortality Electronic Health Records - trends Female Follow-Up Studies Heart Rate - drug effects Heart Rate - physiology Humans Male Middle Aged Treatment Outcome
Title	β-blocker therapy and cardiac events among patients with newly diagnosed coronary heart disease
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