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Age and Ageing Advance Access originally published online on June 24, 2004
Age and Ageing 2004 33(5):467-472; doi:10.1093/ageing/afh150
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Age and Aging Vol. 33 No. 5 © British Geriatrics Society 2004; all rights reserved

Research Paper

Age is not a significant risk factor for failed trial of beta-blocker therapy in older patients with chronic heart failure

Miles D. Witham1, Neil D. Gillespie1 and Allan D. Struthers2

1 Section of Ageing and Health, 2 Department of Clinical Pharmacology, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK

Address correspondence to: M. D. Witham. Fax: (+44) 1382 660675. Email: m.witham{at}dundee.ac.uk

Abstract

Objectives: to evaluate how well older heart failure patients tolerate beta-blockers in everyday clinical practice.

Design: retrospective casenote analysis.

Setting: specialist heart failure clinic in a large teaching hospital.

Participants: 226 patients with a clinical diagnosis of heart failure and evidence of left ventricular systolic dysfunction.

Measurements: data on age, sex, comorbid illness, other medications, duration of beta-blocker therapy, side-effects and reasons for discontinuation.

Results: patients aged 75 years and over had a higher level of comorbid disease and worse New York Heart Association status. Despite this, 60.4% of those aged 75 or over had been tried on a beta-blocker (versus 69% of those aged <75), and of those tried, 80% of those aged 75 or over were still taking a beta-blocker at the time of survey (versus 86% of those aged <75). Forty-seven percent of those aged 75 or over had at least one side-effect recorded (versus 48% of those aged <75). Significant risk factors for failing a trial of beta-blocker therapy were worse New York Heart Association status and worse left ventricular function, but importantly not age.

Conclusions: a high proportion of older heart failure patients tolerate beta-blockers. Side-effects and failure rates are comparable to younger patients. Left ventricular function and worse New York Heart Association class, rather than age, predict low tolerability of therapy. Further studies are warranted to evaluate whether frail patients with heart failure can improve their quality of life by taking beta-blockers.

Keywords: heart failure, congestive, beta-adrenergic blockers, aged, elderly

Received October 30, 2003; Revision received March 5, 2004. accepted in revised form March 5, 2004.


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