Beta-Blockade With Nebivolol in Elderly Heart Failure Patients With Impaired and Preserved Left Ventricular Ejection Fraction: Data From SENIORS (Study of Effects of Nebivolol Intervention on Outcomes and Rehospitalization in Seniors With Heart Failure)
Identifieur interne : 008451 ( Main/Exploration ); précédent : 008450; suivant : 008452Beta-Blockade With Nebivolol in Elderly Heart Failure Patients With Impaired and Preserved Left Ventricular Ejection Fraction: Data From SENIORS (Study of Effects of Nebivolol Intervention on Outcomes and Rehospitalization in Seniors With Heart Failure)
Auteurs : Dirk J. Van Veldhuisen [Pays-Bas] ; Alain Cohen-Solal [France] ; Michael Böhm [Allemagne] ; Stefan D. Anker [Allemagne] ; Daphne Babalis [Royaume-Uni] ; Michael Roughton [Royaume-Uni] ; Andrew J. S. Coats [Australie] ; Philip A. Poole-Wilson [Royaume-Uni] ; Marcus D. Flather [Royaume-Uni]Source :
- Journal of the American College of Cardiology [ 0735-1097 ] ; 2009.
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Abstract
Objectives In this pre-specified subanalysis of the SENIORS (Study of Effects of Nebivolol Intervention on Outcomes and Rehospitalization in Seniors With Heart Failure) trial, which examined the effects of nebivolol in elderly heart failure (HF) patients, we explored the effects of left ventricular ejection fraction (EF) on outcomes, including the subgroups impaired EF (≤35%) and preserved EF (>35%). Background Beta-blockers are established drugs in patients with HF and impaired EF, but their value in preserved EF is unclear. Methods We studied 2,111 patients; 1,359 (64%) had impaired (≤35%) EF (mean 28.7%) and 752 (36%) had preserved (>35%) EF (mean 49.2%). The effect of nebivolol was investigated in these 2 groups, and it was compared to explore the interaction of EF with outcome. Follow-up was 21 months; the primary end point was all-cause mortality or cardiovascular hospitalizations. Results Patients with preserved EF were more often women (49.9% vs. 29.8%) and had less advanced HF, more hypertension, and fewer prior myocardial infarctions (all p < 0.001). During follow-up, the primary end point occurred in 465 patients (34.2%) with impaired EF and in 235 patients (31.2%) with preserved EF. The effect of nebivolol on the primary end point (hazard ratio [HR] of nebivolol vs. placebo) was 0.86 (95% confidence interval: 0.72 to 1.04) in patients with impaired EF and 0.81 (95% confidence interval: 0.63 to 1.04) in preserved EF (p = 0.720 for subgroup interaction). Effects on all secondary end points were similar between groups (HR for all-cause mortality 0.84 and 0.91, respectively), and no p value for interaction was <0.48. Conclusions The effect of beta-blockade with nebivolol in elderly patients with HF in this study was similar in those with preserved and impaired EF.
Affiliations:
- Allemagne, Australie, France, Pays-Bas, Royaume-Uni
- Angleterre, Berlin, Grand Londres, Groningue (province), Nouvelle-Galles du Sud, Île-de-France
- Berlin, Groningue, Londres, Paris, Sydney
- Université de Sydney
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S." last="Coats">Andrew J. S. Coats</name><affiliation wicri:level="4"><inist:fA14 i1="06"><s1>Faculty of Medicine, University of Sydney</s1><s2>Sydney</s2><s3>AUS</s3><sZ>7 aut.</sZ></inist:fA14><country>Australie</country><placeName><settlement type="city">Sydney</settlement><region type="état">Nouvelle-Galles du Sud</region><settlement type="city">Sydney</settlement></placeName><orgName type="university">Université de Sydney</orgName></affiliation></author><author><name sortKey="Poole Wilson, Philip A" sort="Poole Wilson, Philip A" uniqKey="Poole Wilson P" first="Philip A." last="Poole-Wilson">Philip A. 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Van Veldhuisen</name><affiliation wicri:level="3"><inist:fA14 i1="01"><s1>Department of Cardiology, University Medical Center Groningen, University of Groningen</s1><s2>Groningen</s2><s3>NLD</s3><sZ>1 aut.</sZ></inist:fA14><country>Pays-Bas</country><placeName><settlement type="city">Groningue</settlement><region nuts="2" type="province">Groningue (province)</region></placeName></affiliation></author><author><name sortKey="Cohen Solal, Alain" sort="Cohen Solal, Alain" uniqKey="Cohen Solal A" first="Alain" last="Cohen-Solal">Alain Cohen-Solal</name><affiliation wicri:level="3"><inist:fA14 i1="02"><s1>Hopital Lariboisiere and INSERM</s1><s2>Paris</s2><s3>FRA</s3><sZ>2 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Bohm, Michael" sort="Bohm, Michael" uniqKey="Bohm M" first="Michael" last="Böhm">Michael Böhm</name><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>University of Saarland</s1><s2>Homburg/Saar</s2><s3>DEU</s3><sZ>3 aut.</sZ></inist:fA14><country>Allemagne</country><wicri:noRegion>Homburg/Saar</wicri:noRegion><wicri:noRegion>University of Saarland</wicri:noRegion><wicri:noRegion>University of Saarland</wicri:noRegion></affiliation></author><author><name sortKey="Anker, Stefan D" sort="Anker, Stefan D" uniqKey="Anker S" first="Stefan D." last="Anker">Stefan D. Anker</name><affiliation wicri:level="3"><inist:fA14 i1="04"><s1>Charite Campus Virchow Klinikum</s1><s2>Berlin</s2><s3>DEU</s3><sZ>4 aut.</sZ></inist:fA14><country>Allemagne</country><placeName><region type="land" nuts="3">Berlin</region><settlement type="city">Berlin</settlement></placeName></affiliation></author><author><name sortKey="Babalis, Daphne" sort="Babalis, Daphne" uniqKey="Babalis D" first="Daphne" last="Babalis">Daphne Babalis</name><affiliation wicri:level="3"><inist:fA14 i1="05"><s1>Clinical Trials and Evaluation Unit, Royal Brompton and Harefield NHS Trust</s1><s2>London</s2><s3>GBR</s3><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ></inist:fA14><country>Royaume-Uni</country><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation></author><author><name sortKey="Roughton, Michael" sort="Roughton, Michael" uniqKey="Roughton M" first="Michael" last="Roughton">Michael Roughton</name><affiliation wicri:level="3"><inist:fA14 i1="05"><s1>Clinical Trials and Evaluation Unit, Royal Brompton and Harefield NHS Trust</s1><s2>London</s2><s3>GBR</s3><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ></inist:fA14><country>Royaume-Uni</country><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation></author><author><name sortKey="Coats, Andrew J S" sort="Coats, Andrew J S" uniqKey="Coats A" first="Andrew J. S." last="Coats">Andrew J. S. Coats</name><affiliation wicri:level="4"><inist:fA14 i1="06"><s1>Faculty of Medicine, University of Sydney</s1><s2>Sydney</s2><s3>AUS</s3><sZ>7 aut.</sZ></inist:fA14><country>Australie</country><placeName><settlement type="city">Sydney</settlement><region type="état">Nouvelle-Galles du Sud</region><settlement type="city">Sydney</settlement></placeName><orgName type="university">Université de Sydney</orgName></affiliation></author><author><name sortKey="Poole Wilson, Philip A" sort="Poole Wilson, Philip A" uniqKey="Poole Wilson P" first="Philip A." last="Poole-Wilson">Philip A. Poole-Wilson</name><affiliation wicri:level="3"><inist:fA14 i1="05"><s1>Clinical Trials and Evaluation Unit, Royal Brompton and Harefield NHS Trust</s1><s2>London</s2><s3>GBR</s3><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ></inist:fA14><country>Royaume-Uni</country><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation></author><author><name sortKey="Flather, Marcus D" sort="Flather, Marcus D" uniqKey="Flather M" first="Marcus D." last="Flather">Marcus D. Flather</name><affiliation wicri:level="3"><inist:fA14 i1="05"><s1>Clinical Trials and Evaluation Unit, Royal Brompton and Harefield NHS Trust</s1><s2>London</s2><s3>GBR</s3><sZ>5 aut.</sZ><sZ>6 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ></inist:fA14><country>Royaume-Uni</country><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation></author></analytic><series><title level="j" type="main">Journal of the American College of Cardiology</title><title level="j" type="abbreviated">J. Am. Coll. Cardiol.</title><idno type="ISSN">0735-1097</idno><imprint><date when="2009">2009</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">Journal of the American College of Cardiology</title><title level="j" type="abbreviated">J. Am. Coll. Cardiol.</title><idno type="ISSN">0735-1097</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Beta blocking agent</term><term>Cardiology</term><term>Circulatory system</term><term>Data</term><term>Elderly</term><term>Evolution</term><term>Heart disease</term><term>Heart failure</term><term>Left</term><term>Nebivolol</term><term>Prognosis</term><term>Rehospitalization</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Insuffisance cardiaque</term><term>Cardiopathie</term><term>Bloquant β-adrénergique</term><term>Nébivolol</term><term>Personne âgée</term><term>Gauche</term><term>Donnée</term><term>Pronostic</term><term>Evolution</term><term>Réhospitalisation</term><term>Appareil circulatoire</term><term>Cardiologie</term></keywords><keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Personne âgée</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Objectives In this pre-specified subanalysis of the SENIORS (Study of Effects of Nebivolol Intervention on Outcomes and Rehospitalization in Seniors With Heart Failure) trial, which examined the effects of nebivolol in elderly heart failure (HF) patients, we explored the effects of left ventricular ejection fraction (EF) on outcomes, including the subgroups impaired EF (≤35%) and preserved EF (>35%). Background Beta-blockers are established drugs in patients with HF and impaired EF, but their value in preserved EF is unclear. Methods We studied 2,111 patients; 1,359 (64%) had impaired (≤35%) EF (mean 28.7%) and 752 (36%) had preserved (>35%) EF (mean 49.2%). The effect of nebivolol was investigated in these 2 groups, and it was compared to explore the interaction of EF with outcome. Follow-up was 21 months; the primary end point was all-cause mortality or cardiovascular hospitalizations. Results Patients with preserved EF were more often women (49.9% vs. 29.8%) and had less advanced HF, more hypertension, and fewer prior myocardial infarctions (all p < 0.001). During follow-up, the primary end point occurred in 465 patients (34.2%) with impaired EF and in 235 patients (31.2%) with preserved EF. The effect of nebivolol on the primary end point (hazard ratio [HR] of nebivolol vs. placebo) was 0.86 (95% confidence interval: 0.72 to 1.04) in patients with impaired EF and 0.81 (95% confidence interval: 0.63 to 1.04) in preserved EF (p = 0.720 for subgroup interaction). Effects on all secondary end points were similar between groups (HR for all-cause mortality 0.84 and 0.91, respectively), and no p value for interaction was <0.48. Conclusions The effect of beta-blockade with nebivolol in elderly patients with HF in this study was similar in those with preserved and impaired EF.</div></front></TEI><affiliations><list><country><li>Allemagne</li><li>Australie</li><li>France</li><li>Pays-Bas</li><li>Royaume-Uni</li></country><region><li>Angleterre</li><li>Berlin</li><li>Grand Londres</li><li>Groningue (province)</li><li>Nouvelle-Galles du Sud</li><li>Île-de-France</li></region><settlement><li>Berlin</li><li>Groningue</li><li>Londres</li><li>Paris</li><li>Sydney</li></settlement><orgName><li>Université de Sydney</li></orgName></list><tree><country name="Pays-Bas"><region name="Groningue (province)"><name sortKey="Van Veldhuisen, Dirk J" sort="Van Veldhuisen, Dirk J" uniqKey="Van Veldhuisen D" first="Dirk J." last="Van Veldhuisen">Dirk J. Van Veldhuisen</name></region></country><country name="France"><region name="Île-de-France"><name sortKey="Cohen Solal, Alain" sort="Cohen Solal, Alain" uniqKey="Cohen Solal A" first="Alain" last="Cohen-Solal">Alain Cohen-Solal</name></region></country><country name="Allemagne"><noRegion><name sortKey="Bohm, Michael" sort="Bohm, Michael" uniqKey="Bohm M" first="Michael" last="Böhm">Michael Böhm</name></noRegion><name sortKey="Anker, Stefan D" sort="Anker, Stefan D" uniqKey="Anker S" first="Stefan D." last="Anker">Stefan D. Anker</name></country><country name="Royaume-Uni"><region name="Angleterre"><name sortKey="Babalis, Daphne" sort="Babalis, Daphne" uniqKey="Babalis D" first="Daphne" last="Babalis">Daphne Babalis</name></region><name sortKey="Flather, Marcus D" sort="Flather, Marcus D" uniqKey="Flather M" first="Marcus D." last="Flather">Marcus D. Flather</name><name sortKey="Poole Wilson, Philip A" sort="Poole Wilson, Philip A" uniqKey="Poole Wilson P" first="Philip A." last="Poole-Wilson">Philip A. Poole-Wilson</name><name sortKey="Roughton, Michael" sort="Roughton, Michael" uniqKey="Roughton M" first="Michael" last="Roughton">Michael Roughton</name></country><country name="Australie"><region name="Nouvelle-Galles du Sud"><name sortKey="Coats, Andrew J S" sort="Coats, Andrew J S" uniqKey="Coats A" first="Andrew J. S." last="Coats">Andrew J. S. Coats</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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