Author(s): Rahman Shah, Yung Wang, JoAnne M Foody
About half of all patients with heart failure (HF) have preserved left ventricular systolic function. Statins, angiotensin-converting enzyme inhibitors, and β blockers have been shown to improve survival in patients with HF and low ejection fraction. However, no large national study has investigated these agents in patients with HF and preserved left ventricular ejection fraction. We evaluated a nationwide sample of 13,533 eligible Medicare beneficiaries aged ≥65 years who were hospitalized with a primary discharge diagnosis of HF and had chart documentation of preserved left ventricular ejection fraction between April 1998 and March 1999 or between July 2000 and June 2001. In Cox proportional hazard model accounting for demographic profile, clinical characteristics, treatments, physician specialty, and hospital characteristics, discharge statin therapy was associated with significant improvements in 1- and 3-year mortality (RR 0.69, 95% confidence interval [CI] 0.61 to 0.78; RR 0.73, 95% CI 0.68 to 0.79, respectively). Irrespective of total cholesterol level or coronary artery disease status, diabetes, hypertension, and age, statin therapy was associated with significant differences in mortality rates. Similarly, angiotensin-converting enzyme inhibitors were associated with better survival at 1 year (RR 0.88, 95% CI 0.82 to 0.95) and 3 years (RR 0.93, 95% CI 0.89 to 0.98). Beta-blocker therapy was associated with a nonsignificant trend at 1 year (RR 0.93, 95% CI 0.87 to 1.10) and significant survival benefits at 3 years (RR 0.92%, 95% CI 0.87 to 0.97). In conclusion, our data demonstrate that statins, angiotensin-converting enzyme inhibitors, and β blockers are associated with better short- and long-term survival in patients ≥65 years with HF and preserved left ventricular ejection fraction. J.M. Foody is supported by National Institutes of Health/National Institute on Aging Research Career Award K08-AG20623-01, a Pepper Foundation Center Grant, and a NIA/Hartford Foundation Fellowship in Geriatrics. J.M. Foody has received honoraria from and served on the speakers’ bureau of Pfizer, Novartis, and Merck. The analyses upon which this publication is based were performed under Contract Number 003_HI-OK0412_0706 funded by the Centers for Medicare and Medicaid Services, an agency of the United States Department of Health and Human Services. The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does the mention of trade names, commercial products, or organizations imply endorsement by the United States Government. The author assumes full responsibility for the accuracy and completeness of the ideas presented.