Evidence map›Paper›PMID 30076815›Full record

ArticleThe American journal of medicine2018

Role of High-Dose Beta-Blockers in Patients with Heart Failure with Preserved Ejection Fraction and Elevated Heart Rate.

Phillip H Lam, Neha Gupta, Daniel J Dooley, Steven Singh, Prakash Deedwania, Michael R Zile, Deepak L Bhatt, Charity J Morgan, Bertram Pitt, Gregg C Fonarow and 1 more

Open access · greenAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in The American journal of medicine, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
20citing papers in PubMed, 2 pooled it
2.9field-weighted citation impact, top 8% of its field
1 · What the graph read from it

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.

2 · The registry

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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

20 citing papers in PubMed, 2 syntheses or guidelines pooled it, 35 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
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  5. Review
  6. Article
  7. Drug Therapy for Acute and Chronic Heart Failure with Preserved Ejection Fraction with Hypertension: A State-of-the-Art Review.American journal of cardiovascular drugs : drugs, devices, and other interventions · 2024
    Review
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  9. Article
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  13. Article
  14. Managing heart failure with preserved ejection fraction.Annals of translational medicine · 2020
    Review
  15. Review
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors at 8 institutions in 1 country.

Phillip H LamVeterans Affairs Medical Center, Washington, DC; Brigham and Women's Hospital Heart & Vascular Center, Boston, Mass.
Neha GuptaVeterans Affairs Medical Center, Washington, DC; Georgetown University, Washington, DC; MedStar Heart and Vascular Institute, Washington, DC.
Daniel J DooleyVeterans Affairs Medical Center, Washington, DC; Georgetown University, Washington, DC; MedStar Heart and Vascular Institute, Washington, DC.
Steven SinghVeterans Affairs Medical Center, Washington, DC; Georgetown University, Washington, DC.
Prakash DeedwaniaVeterans Affairs Medical Center, Washington, DC; University of California, San Francisco, Fresno.
Michael R ZileRalph H. Johnson VA Medical Center and Medical University of South Carolina, Charleston.
Deepak L BhattBrigham and Women's Hospital Heart & Vascular Center, Boston, Mass; Harvard Medical School, Boston, Mass.
Charity J MorganUniversity of Alabama at Birmingham, Ann Arbor.
Bertram PittUniversity of Michigan, Ann Arbor.
Gregg C FonarowUniversity of California, Los Angeles.
Ali AhmedVeterans Affairs Medical Center, Washington, DC; George Washington University, Washington, DC. Electronic address: ali.ahmed@va.gov.
Georgetown University · USBrigham and Women's Hospital · USGeorge Washington University · USMedical University of South Carolina · USSan Francisco VA Medical Center · USUniversity of Alabama at Birmingham · USUniversity of California, Los Angeles · USUniversity of Michigan · US

Funding

Heart failure, chronic kidney disease, and renin-angiotensin system inhibitionR01HL085561 · NHLBI · UNIVERSITY OF ALABAMA AT BIRMINGHAM · PI AHMED, ALI · 2006 to 2009
$1.5M
Neurohormonal Blockade and Outcomes in Diastolic Heart FailureR01HL097047 · NHLBI · UNIVERSITY OF ALABAMA AT BIRMINGHAM · PI AHMED, ALI · 2009 to 2010
$915k
NHLBI NIH HHS R01 HL085561NHLBI NIH HHS R01 HL097047
6 · The paper itself

Abstract

backgroundBeta-blockers in high target doses are recommended for heart failure with reduced ejection fraction (HFrEF) but not for preserved ejection fraction (HFpEF). Treatment benefits are often more pronounced in high-risk subgroups, and patients with HFpEF with heart rate ≥70 beats per minute have emerged as such a high-risk subgroup. We examined the associations of high-dose beta-blocker use with outcomes in these patients.

methodsOf the 8462 hospitalized patients with heart failure with ejection fraction ≥50% in the Medicare-linked Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF) registry, 5422 had a discharge heart rate ≥70 beats per minute. Of these, 4537 had no contraindications to beta-blocker use, of which 2797 (2592 with dose data) received prescriptions for beta-blockers. Of the 2592, 730 received high-dose beta-blockers, defined as atenolol ≥100 mg/day, carvedilol ≥50 mg/day, metoprolol tartrate or succinate ≥200 mg/day, or bisoprolol ≥10 mg/day, and 1740 received no beta-blockers. Using propensity scores for the receipt of high-dose beta-blockers, we assembled a matched cohort of 1280 patients, balanced on 58 characteristics.

resultsAll-cause mortality occurred in 63% and 68% of matched patients receiving high-dose beta-blocker vs no beta-blocker, respectively, during 6 years (median, 2.8) of follow-up (hazard ratio, 0.86; 95% confidence interval, 0.75-0.98; P = .027). The hazard ratios (95% confidence intervals) for all-cause readmission and the combined endpoint of all-cause readmission or all-cause mortality associated with high-dose beta-blocker use were 0.90 (0.81-1.02) and 0.89 (0.80-1.00), respectively.

conclusionsIn patients with HFpEF and heart rate ≥70 beats per minute, high-dose beta-blocker use was associated with a significantly lower risk of death. Future randomized controlled trials are needed to examine this association.

Indexed as

Stroke VolumeAdrenergic beta-AntagonistsAgedAged, 80 and overDose-Response Relationship, DrugHeart FailureHeart RateHumansLogistic ModelsPropensity ScoreAdrenergic beta-AntagonistsAll-cause mortalityHeart failure with preserved ejection fractionHeart rateHigh-dose beta-blocker

Identifiers

PMID30076815
PMCPMC10463568
OpenAlexW2887547688

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

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.