The use of beta blockers may offer protection against adverse health outcomes in patients diagnosed with both heart disease and dementia, according to a new study.
Heart failure with reduced ejection fraction (HFrEF) is a key public health issue and is linked to high morbidity and mortality. The researchers aimed to investigate the use of beta blockers, which are used to reduce blood pressure and treat heart conditions, in patients who most commonly have this diagnosis.
Many patients with HFrEF are older adults and those with cognitive impairment, the study’s authors noted. These patients are not typically included in clinical trials, and the risk-to-benefit trade-off of routine beta-blocker use in patients with both HFrEF and Alzheimer’s disease or related dementias (ADRD) has not previously been explored, they added.
The study included a random sample of Medicare Parts A, B and D data in patients hospitalized one or more times for HFrEF between 2008 and 2018. Patients were classified based on beta-blocker use before hospital admission and after discharge.
Fully 13% of the more than 350,000 patients hospitalized with HFrEF had dementia. Patients with both HFrEF and dementia had higher 90-day and 1-year mortality when compared to patients with HFrEF only, the researchers reported.
Higher risk
Among patients who were taking beta blockers at admission, discontinuing the drug was associated with a more than twofold higher risk of 90-day mortality in patients with heart failure only and a twofold higher risk of 90-day mortality in those with both HFrEF and dementia.
In addition, not starting a beta blocker was associated with a 1.8-fold higher risk of 90-day mortality for those with HFrEF-only and a 1.7-fold higher risk of 90-day mortality among patients with HFrEF and dementia. At a one-year follow up, the risks remained similar.
Nursing home residents
Prior studies have also supported the use of beta blocker use in patients with heart failure alone. In a nursing home study published in May 2022, for example, beta-blocker use was linked to a lower risk of all-cause mortality in older residents with HFrEF — although it did not reduce heart failure readmissions.
“[Beta blocker] therapy is associated with significantly lower short- and long-term mortality rates among all patients with HFrEF,” the current study’s authors wrote. “The magnitude of these associated benefits appear at least as large in patients with HFrEF and ADRD compared to patients with HFrEF-only.”
The study was published in the Journal of the American Geriatrics Society.
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