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. 2014 Nov;7(6):945-52.
doi: 10.1161/CIRCHEARTFAILURE.114.001301. Epub 2014 Oct 8.

Calcium channel blockers and outcomes in older patients with heart failure and preserved ejection fraction

Kanan Patel  1 , Gregg C Fonarow  1 , Momanna Ahmed  1 , Charity Morgan  1 , Meredith Kilgore  1 , Thomas E Love  1 , Prakash Deedwania  1 , Wilbert S Aronow  1 , Stefan D Anker  1 , Ali Ahmed  2
Affiliations

Calcium channel blockers and outcomes in older patients with heart failure and preserved ejection fraction

Kanan Patel et al. Circ Heart Fail. 2014 Nov.

Abstract

Background: Little is known about associations of calcium channel blockers (CCBs) with outcomes in patients with heart failure and preserved ejection fraction (EF).

Methods and results: Of the 10 570 hospitalized patients with heart failure and preserved EF, ≥65 years, EF ≥40%, in the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF; 2003-2004), linked to Medicare data (through December 31, 2008), 7514 had no prior history of CCB use. Of these, 815 (11%) patients received new discharge prescriptions for CCBs. Propensity scores for CCB initiation, calculated for each of the 7514 patients, were used to assemble a matched cohort of 1620 (810 pairs) patients (mean age, 80 years; mean EF, 56%; 65% women; 10% black) receiving and not receiving CCBs, balanced on 114 baseline characteristics. The primary composite end point of all-cause mortality or heart failure hospitalization occurred in 82% and 81% of patients receiving and not receiving CCBs (hazard ratio for CCBs, 1.03; 95% confidence interval, 0.92-1.14). Hazard ratios (95% confidence intervals) for all-cause mortality, heart failure hospitalization, and all-cause hospitalization were 1.05 (0.94-1.18), 1.05 (0.91-1.21), and 1.03 (0.93-1.14), respectively. Similar associations were observed when we categorized patients into those receiving amlodipine and nonamlodipine CCBs. Among 7514 prematch patients, multivariable-adjusted and propensity-adjusted hazard ratios (95% confidence interval) for primary composite end point were 1.03 (0.95-1.12) and 1.02 (0.94-1.11), respectively.

Conclusions: In hospitalized older patients with heart failure, new discharge prescriptions for CCBs had no associations with composite or individual end points of mortality or heart failure hospitalization, regardless of the class of CCBs.

Keywords: calcium channel blockers; heart failure.

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Figures

Figure 1
Figure 1
Love plot displaying absolute standardized differences comparing 114 baseline characteristics between older patients with heart failure and preserved ejection fraction, receiving a new discharge prescription of calcium channel blockers, before and after propensity score matching (Hx=past medical history, A=admission, D=discharge, H=in-hospital, PF=precipitating factor, ACE=angiotensin-converting enzyme, *4 regions entered as single categorical variable in the model)
Figure 2
Figure 2
Kaplan-Meier plot for primary composite endpoint of all-cause mortality or heart failure hospitalization in a propensity-matched inception cohort of older patients with heart failure and preserved ejection fraction, receiving and not receiving a new discharge prescription for calcium channel blockers (CCB) (HR=hazard ratio, CI=confidence interval)
Figure 3
Figure 3
Association of a new discharge prescription for calcium channel blockers (CCB) with primary composite endpoint of all-cause mortality or heart failure hospitalization in subgroups of propensity-matched inception cohort of older patients with heart failure and preserved ejection fraction
See this image and copyright information in PMC

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