Trial reportCirculation. Heart failure2015
Characteristics and outcomes of patients with advanced chronic systolic heart failure receiving care at the Veterans Affairs versus other hospitals: insights from the Beta-blocker Evaluation of Survival Trial (BEST).
Registry-linked trialOpen access · bronzeAbstract readMulticenter StudyRandomized Controlled Trial
In one paragraph
Trial report in Circulation. Heart failure, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT00000560 (Beta-Blocker Evaluation in Survival Trial), which is not on this map. Cited by 10 papers, 3 of them syntheses that pooled it.
0numbers the graph read from it
0cells of the map it votes in
10citing papers in PubMed, 3 pooled it
0.8field-weighted citation impact, top 23% of its field
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Beta-Blocker Evaluation in Survival Trial (BEST)
Who cites it
10 citing papers in PubMed, 3 syntheses or guidelines pooled it, 15 citations in OpenAlex.
- Veterans Health Administration (VA) vs. Non-VA Healthcare Quality: A Systematic Review.Journal of general internal medicine · 2023Pooled it
- Factors associated with hospitalisations of patients with chronic heart failure approaching the end of life: A systematic review.Palliative medicine · 2022Pooled it
- Pharmacological interventions for heart failure in people with chronic kidney disease.The Cochrane database of systematic reviews · 2020Pooled it
- Depression and Heart Failure in US Veterans.JAMA network open · 2025Article
- Impact of the COVID-19 Pandemic on the Provision of Dialysis Service and Mortality in Veterans Receiving Maintenance Hemodialysis in the VA: An Interrupted Time-Series Analysis.American journal of nephrology · 2023Article
- Alzheimer's Disease and Alzheimer's Disease-Related Dementias in Older African American and White Veterans.Journal of Alzheimer's disease : JAD · 2020Article
- Heart Failure Dashboard Design and Validation to Improve Care of Veterans.Applied clinical informatics · 2020Article
- Mortality Disparities in Racial/Ethnic Minority Groups in the Veterans Health Administration: An Evidence Review and Map.American journal of public health · 2018Review
- Article
- Temporal Trends and Hospital Variation in Mineralocorticoid Receptor Antagonist Use in Veterans Discharged With Heart Failure.Journal of the American Heart Association · 2015Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
14 authors at 1 institution in 1 country.
Linda G JonesFrom the Department of Medicine, Veterans Affairs Medical Center, Birmingham, AL (L.G.J., F.G.H., S.D.P.); Department of Medicine (L.G.J., F.G.H., S.D.P.) and Department of Biostatistics (C.J.M.), University of Alabama at Birmingham; Department of Adult Health, Seattle University College of Nursing, Seattle, WA (M.-K.S.); Office of the Chief of Staff, Veterans Affairs Medical Center, Washington, DC (R.E.K., R.D.F., A.A.); Department of Medicine, The Ralph H. Johnson Veterans Affairs Medical Center, Charleston, (M.R.Z.); Department of Medicine, Medical University of South Carolina, Charleston (M.R.Z.); Department of Medicine, Veterans Affairs Medical Center, Providence, RI (W.-C.W.); Department of Medicine, Brown University, Providence, RI (W.-C.W.); Department of Medicine, University of California, San Francisco, Fresno (P.D.); Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, New York Medical College, Valhalla (W.S.A.); and Department of Veterans Affairs, Geriatrics and Extended Care Services, Washington, DC (R.M.A.).
Mo-Kyung SinFrom the Department of Medicine, Veterans Affairs Medical Center, Birmingham, AL (L.G.J., F.G.H., S.D.P.); Department of Medicine (L.G.J., F.G.H., S.D.P.) and Department of Biostatistics (C.J.M.), University of Alabama at Birmingham; Department of Adult Health, Seattle University College of Nursing, Seattle, WA (M.-K.S.); Office of the Chief of Staff, Veterans Affairs Medical Center, Washington, DC (R.E.K., R.D.F., A.A.); Department of Medicine, The Ralph H. Johnson Veterans Affairs Medical Center, Charleston, (M.R.Z.); Department of Medicine, Medical University of South Carolina, Charleston (M.R.Z.); Department of Medicine, Veterans Affairs Medical Center, Providence, RI (W.-C.W.); Department of Medicine, Brown University, Providence, RI (W.-C.W.); Department of Medicine, University of California, San Francisco, Fresno (P.D.); Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, New York Medical College, Valhalla (W.S.A.); and Department of Veterans Affairs, Geriatrics and Extended Care Services, Washington, DC (R.M.A.).
Fadi G HageFrom the Department of Medicine, Veterans Affairs Medical Center, Birmingham, AL (L.G.J., F.G.H., S.D.P.); Department of Medicine (L.G.J., F.G.H., S.D.P.) and Department of Biostatistics (C.J.M.), University of Alabama at Birmingham; Department of Adult Health, Seattle University College of Nursing, Seattle, WA (M.-K.S.); Office of the Chief of Staff, Veterans Affairs Medical Center, Washington, DC (R.E.K., R.D.F., A.A.); Department of Medicine, The Ralph H. Johnson Veterans Affairs Medical Center, Charleston, (M.R.Z.); Department of Medicine, Medical University of South Carolina, Charleston (M.R.Z.); Department of Medicine, Veterans Affairs Medical Center, Providence, RI (W.-C.W.); Department of Medicine, Brown University, Providence, RI (W.-C.W.); Department of Medicine, University of California, San Francisco, Fresno (P.D.); Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, New York Medical College, Valhalla (W.S.A.); and Department of Veterans Affairs, Geriatrics and Extended Care Services, Washington, DC (R.M.A.).
Raya E KheirbekFrom the Department of Medicine, Veterans Affairs Medical Center, Birmingham, AL (L.G.J., F.G.H., S.D.P.); Department of Medicine (L.G.J., F.G.H., S.D.P.) and Department of Biostatistics (C.J.M.), University of Alabama at Birmingham; Department of Adult Health, Seattle University College of Nursing, Seattle, WA (M.-K.S.); Office of the Chief of Staff, Veterans Affairs Medical Center, Washington, DC (R.E.K., R.D.F., A.A.); Department of Medicine, The Ralph H. Johnson Veterans Affairs Medical Center, Charleston, (M.R.Z.); Department of Medicine, Medical University of South Carolina, Charleston (M.R.Z.); Department of Medicine, Veterans Affairs Medical Center, Providence, RI (W.-C.W.); Department of Medicine, Brown University, Providence, RI (W.-C.W.); Department of Medicine, University of California, San Francisco, Fresno (P.D.); Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, New York Medical College, Valhalla (W.S.A.); and Department of Veterans Affairs, Geriatrics and Extended Care Services, Washington, DC (R.M.A.).
Charity J MorganFrom the Department of Medicine, Veterans Affairs Medical Center, Birmingham, AL (L.G.J., F.G.H., S.D.P.); Department of Medicine (L.G.J., F.G.H., S.D.P.) and Department of Biostatistics (C.J.M.), University of Alabama at Birmingham; Department of Adult Health, Seattle University College of Nursing, Seattle, WA (M.-K.S.); Office of the Chief of Staff, Veterans Affairs Medical Center, Washington, DC (R.E.K., R.D.F., A.A.); Department of Medicine, The Ralph H. Johnson Veterans Affairs Medical Center, Charleston, (M.R.Z.); Department of Medicine, Medical University of South Carolina, Charleston (M.R.Z.); Department of Medicine, Veterans Affairs Medical Center, Providence, RI (W.-C.W.); Department of Medicine, Brown University, Providence, RI (W.-C.W.); Department of Medicine, University of California, San Francisco, Fresno (P.D.); Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, New York Medical College, Valhalla (W.S.A.); and Department of Veterans Affairs, Geriatrics and Extended Care Services, Washington, DC (R.M.A.).
Michael R ZileFrom the Department of Medicine, Veterans Affairs Medical Center, Birmingham, AL (L.G.J., F.G.H., S.D.P.); Department of Medicine (L.G.J., F.G.H., S.D.P.) and Department of Biostatistics (C.J.M.), University of Alabama at Birmingham; Department of Adult Health, Seattle University College of Nursing, Seattle, WA (M.-K.S.); Office of the Chief of Staff, Veterans Affairs Medical Center, Washington, DC (R.E.K., R.D.F., A.A.); Department of Medicine, The Ralph H. Johnson Veterans Affairs Medical Center, Charleston, (M.R.Z.); Department of Medicine, Medical University of South Carolina, Charleston (M.R.Z.); Department of Medicine, Veterans Affairs Medical Center, Providence, RI (W.-C.W.); Department of Medicine, Brown University, Providence, RI (W.-C.W.); Department of Medicine, University of California, San Francisco, Fresno (P.D.); Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, New York Medical College, Valhalla (W.S.A.); and Department of Veterans Affairs, Geriatrics and Extended Care Services, Washington, DC (R.M.A.).
Wen-Chih WuFrom the Department of Medicine, Veterans Affairs Medical Center, Birmingham, AL (L.G.J., F.G.H., S.D.P.); Department of Medicine (L.G.J., F.G.H., S.D.P.) and Department of Biostatistics (C.J.M.), University of Alabama at Birmingham; Department of Adult Health, Seattle University College of Nursing, Seattle, WA (M.-K.S.); Office of the Chief of Staff, Veterans Affairs Medical Center, Washington, DC (R.E.K., R.D.F., A.A.); Department of Medicine, The Ralph H. Johnson Veterans Affairs Medical Center, Charleston, (M.R.Z.); Department of Medicine, Medical University of South Carolina, Charleston (M.R.Z.); Department of Medicine, Veterans Affairs Medical Center, Providence, RI (W.-C.W.); Department of Medicine, Brown University, Providence, RI (W.-C.W.); Department of Medicine, University of California, San Francisco, Fresno (P.D.); Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, New York Medical College, Valhalla (W.S.A.); and Department of Veterans Affairs, Geriatrics and Extended Care Services, Washington, DC (R.M.A.).
Prakash DeedwaniaFrom the Department of Medicine, Veterans Affairs Medical Center, Birmingham, AL (L.G.J., F.G.H., S.D.P.); Department of Medicine (L.G.J., F.G.H., S.D.P.) and Department of Biostatistics (C.J.M.), University of Alabama at Birmingham; Department of Adult Health, Seattle University College of Nursing, Seattle, WA (M.-K.S.); Office of the Chief of Staff, Veterans Affairs Medical Center, Washington, DC (R.E.K., R.D.F., A.A.); Department of Medicine, The Ralph H. Johnson Veterans Affairs Medical Center, Charleston, (M.R.Z.); Department of Medicine, Medical University of South Carolina, Charleston (M.R.Z.); Department of Medicine, Veterans Affairs Medical Center, Providence, RI (W.-C.W.); Department of Medicine, Brown University, Providence, RI (W.-C.W.); Department of Medicine, University of California, San Francisco, Fresno (P.D.); Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, New York Medical College, Valhalla (W.S.A.); and Department of Veterans Affairs, Geriatrics and Extended Care Services, Washington, DC (R.M.A.).
Gregg C FonarowFrom the Department of Medicine, Veterans Affairs Medical Center, Birmingham, AL (L.G.J., F.G.H., S.D.P.); Department of Medicine (L.G.J., F.G.H., S.D.P.) and Department of Biostatistics (C.J.M.), University of Alabama at Birmingham; Department of Adult Health, Seattle University College of Nursing, Seattle, WA (M.-K.S.); Office of the Chief of Staff, Veterans Affairs Medical Center, Washington, DC (R.E.K., R.D.F., A.A.); Department of Medicine, The Ralph H. Johnson Veterans Affairs Medical Center, Charleston, (M.R.Z.); Department of Medicine, Medical University of South Carolina, Charleston (M.R.Z.); Department of Medicine, Veterans Affairs Medical Center, Providence, RI (W.-C.W.); Department of Medicine, Brown University, Providence, RI (W.-C.W.); Department of Medicine, University of California, San Francisco, Fresno (P.D.); Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, New York Medical College, Valhalla (W.S.A.); and Department of Veterans Affairs, Geriatrics and Extended Care Services, Washington, DC (R.M.A.).
Wilbert S AronowFrom the Department of Medicine, Veterans Affairs Medical Center, Birmingham, AL (L.G.J., F.G.H., S.D.P.); Department of Medicine (L.G.J., F.G.H., S.D.P.) and Department of Biostatistics (C.J.M.), University of Alabama at Birmingham; Department of Adult Health, Seattle University College of Nursing, Seattle, WA (M.-K.S.); Office of the Chief of Staff, Veterans Affairs Medical Center, Washington, DC (R.E.K., R.D.F., A.A.); Department of Medicine, The Ralph H. Johnson Veterans Affairs Medical Center, Charleston, (M.R.Z.); Department of Medicine, Medical University of South Carolina, Charleston (M.R.Z.); Department of Medicine, Veterans Affairs Medical Center, Providence, RI (W.-C.W.); Department of Medicine, Brown University, Providence, RI (W.-C.W.); Department of Medicine, University of California, San Francisco, Fresno (P.D.); Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, New York Medical College, Valhalla (W.S.A.); and Department of Veterans Affairs, Geriatrics and Extended Care Services, Washington, DC (R.M.A.).
Sumanth D PrabhuFrom the Department of Medicine, Veterans Affairs Medical Center, Birmingham, AL (L.G.J., F.G.H., S.D.P.); Department of Medicine (L.G.J., F.G.H., S.D.P.) and Department of Biostatistics (C.J.M.), University of Alabama at Birmingham; Department of Adult Health, Seattle University College of Nursing, Seattle, WA (M.-K.S.); Office of the Chief of Staff, Veterans Affairs Medical Center, Washington, DC (R.E.K., R.D.F., A.A.); Department of Medicine, The Ralph H. Johnson Veterans Affairs Medical Center, Charleston, (M.R.Z.); Department of Medicine, Medical University of South Carolina, Charleston (M.R.Z.); Department of Medicine, Veterans Affairs Medical Center, Providence, RI (W.-C.W.); Department of Medicine, Brown University, Providence, RI (W.-C.W.); Department of Medicine, University of California, San Francisco, Fresno (P.D.); Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, New York Medical College, Valhalla (W.S.A.); and Department of Veterans Affairs, Geriatrics and Extended Care Services, Washington, DC (R.M.A.).
Ross D FletcherFrom the Department of Medicine, Veterans Affairs Medical Center, Birmingham, AL (L.G.J., F.G.H., S.D.P.); Department of Medicine (L.G.J., F.G.H., S.D.P.) and Department of Biostatistics (C.J.M.), University of Alabama at Birmingham; Department of Adult Health, Seattle University College of Nursing, Seattle, WA (M.-K.S.); Office of the Chief of Staff, Veterans Affairs Medical Center, Washington, DC (R.E.K., R.D.F., A.A.); Department of Medicine, The Ralph H. Johnson Veterans Affairs Medical Center, Charleston, (M.R.Z.); Department of Medicine, Medical University of South Carolina, Charleston (M.R.Z.); Department of Medicine, Veterans Affairs Medical Center, Providence, RI (W.-C.W.); Department of Medicine, Brown University, Providence, RI (W.-C.W.); Department of Medicine, University of California, San Francisco, Fresno (P.D.); Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, New York Medical College, Valhalla (W.S.A.); and Department of Veterans Affairs, Geriatrics and Extended Care Services, Washington, DC (R.M.A.).
Ali AhmedFrom the Department of Medicine, Veterans Affairs Medical Center, Birmingham, AL (L.G.J., F.G.H., S.D.P.); Department of Medicine (L.G.J., F.G.H., S.D.P.) and Department of Biostatistics (C.J.M.), University of Alabama at Birmingham; Department of Adult Health, Seattle University College of Nursing, Seattle, WA (M.-K.S.); Office of the Chief of Staff, Veterans Affairs Medical Center, Washington, DC (R.E.K., R.D.F., A.A.); Department of Medicine, The Ralph H. Johnson Veterans Affairs Medical Center, Charleston, (M.R.Z.); Department of Medicine, Medical University of South Carolina, Charleston (M.R.Z.); Department of Medicine, Veterans Affairs Medical Center, Providence, RI (W.-C.W.); Department of Medicine, Brown University, Providence, RI (W.-C.W.); Department of Medicine, University of California, San Francisco, Fresno (P.D.); Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, New York Medical College, Valhalla (W.S.A.); and Department of Veterans Affairs, Geriatrics and Extended Care Services, Washington, DC (R.M.A.). aliahmedmdmph@gmail.com.
Richard M AllmanFrom the Department of Medicine, Veterans Affairs Medical Center, Birmingham, AL (L.G.J., F.G.H., S.D.P.); Department of Medicine (L.G.J., F.G.H., S.D.P.) and Department of Biostatistics (C.J.M.), University of Alabama at Birmingham; Department of Adult Health, Seattle University College of Nursing, Seattle, WA (M.-K.S.); Office of the Chief of Staff, Veterans Affairs Medical Center, Washington, DC (R.E.K., R.D.F., A.A.); Department of Medicine, The Ralph H. Johnson Veterans Affairs Medical Center, Charleston, (M.R.Z.); Department of Medicine, Medical University of South Carolina, Charleston (M.R.Z.); Department of Medicine, Veterans Affairs Medical Center, Providence, RI (W.-C.W.); Department of Medicine, Brown University, Providence, RI (W.-C.W.); Department of Medicine, University of California, San Francisco, Fresno (P.D.); Department of Medicine, University of California, Los Angeles (G.C.F.); Department of Medicine, New York Medical College, Valhalla (W.S.A.); and Department of Veterans Affairs, Geriatrics and Extended Care Services, Washington, DC (R.M.A.).
Department of Veterans Affairs · AU
Funding
Heart failure, chronic kidney disease, and renin-angiotensin system inhibitionR01HL085561 · NHLBI · UNIVERSITY OF ALABAMA AT BIRMINGHAM · PI AHMED, ALI · 2006 to 2009
$1.5MNeurohormonal Blockade and Outcomes in Diastolic Heart FailureR01HL097047 · NHLBI · UNIVERSITY OF ALABAMA AT BIRMINGHAM · PI AHMED, ALI · 2009 to 2010
$915kNHLBI NIH HHS R01 HL085561NHLBI NIH HHS R01-HL085561NHLBI NIH HHS R01 HL097047NHLBI NIH HHS R01-HL097047
Abstract
backgroundCharacteristics and outcomes of patients with heart failure and reduced ejection fraction receiving care at Veterans Affairs (VA) versus non-VA hospitals have not been previously reported. METHODS AND
resultsIn the randomized controlled Beta-blocker Evaluation of Survival Trial (BEST; 1995-1999), of the 2707 (bucindolol=1353; placebo=1354) patients with heart failure and left ventricular ejection fraction ≤35%, 918 received care at VA hospitals, of which 98% (n=898) were male. Of the 1789 receiving care at non-VA hospitals, 68% (n=1216) were male. Our analyses were restricted to these 2114 male patients. VA patients were older with higher symptom and comorbidity burdens. There was no significant between-group difference in unadjusted primary end point of 2-year all-cause mortality (35% VA versus 32% non-VA; hazard ratio associated with VA hospitals, 1.09; 95% confidence interval, 0.94-1.26), which remained unchanged after adjustment for age and race (hazard ratio, 1.00; 95% confidence interval, 0.86-1.16) or multivariable adjustment, including cardiovascular morbidities (hazard ratio, 0.94; 95% confidence interval, 0.80-1.10). There was no between-group difference in cause-specific mortalities or hospitalizations. Chronic kidney disease, pulmonary edema, left ventricular ejection fraction <20%, and peripheral arterial disease were significant predictors of mortality for both groups. African America race, New York Heart Association class IV symptoms, atrial fibrillation, and right ventricular ejection fraction <20% were associated with higher mortality among non-VA hospital patients only; however, these differences from VA patients were not significant.
conclusionsPatients with heart failure and reduced ejection fraction receiving care at VA hospitals were older and sicker; yet their risk of mortality and hospitalization was similar to younger and healthier patients receiving care at non-VA hospitals. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00000560.
Indexed as
Adrenergic beta-AntagonistsFemaleFollow-Up StudiesHeart Failure, SystolicHospitalizationHospitalsHumansMaleMiddle AgedPrognosisRetrospective StudiesStroke VolumeSurvival RateTreatment OutcomeUnited StatesUnited States Department of Veterans AffairsAdrenergic beta-Antagonistshospitalsoutcomessystolic heart failureveterans
Identifiers
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Registered trials
NCT00000560ClinicalTrials.gov
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.