High selenium levels associate with reduced risk of mortality and new onset heart failure: data from PREVEND

Introduction: In patients with heart failure (HF) and ischemic heart disease (IHD), beta-blockers (BB) are associated with improved mortality. However, in patients with co-morbid chronic obstructive pulmonary disease (COPD), this drug class is less utilized due to concerns about an unfavorable impact on the morbidity and mortality. Patients with COPD and heart disease have higher mortality than those with heart disease alone. There is a need to clarify the safety of BB in this population. Objective: To assess the effect of BB therapy on mortality in patients with heart disease and COPD. Methods: We performed a systematic search of MEDLINE and PubMed inception until May 30, 2020 to identify articles of BB use in patients with COPD. The risk ratio (RR) of mortality with BB use was calculated using the Mantel Haenszel random effect model. Statistical analysis was performed using Review Manager Web (RevMan Web). A two-sided p value of < 0.05 was considered statistically significant. Results: A total of 16 studies were included in this meta-analysis, comprising 133,538 patients (44,893 received BB, 88,381 received no control drug, and 264 received placebo). BB use was associated with reduced risk of mortality overall (14.8% vs. 19.9%, RR: 0.67, 95% CI: 0.57 - 0.79), in patients with IHD (18.6% vs. 26.6%, RR: 0.64, 95% CI: 0.50 - 0.82), and in patients with HF (8.1% vs. 23.6%, RR: 0.56, 95% CI: 0.41 - 0.75), Figure. BB were used to treat hypertension in one study, and it was associated with reduced risk of mortality (6.2% vs. 13.4%, RR: 0.46, 95% CI: 0.28 - 0.78). In contrast, βB use was not associated with statistically significant reduced risk of mortality when given without a specified cardiovascular indication (25.0% vs. 32.5%, RR: 0.82, 95% CI: 0.59 - 1.15), figure. Conclusion: Beta-blockers are associated with improved mortality in patients with HF or IHD and COPD. A diagnosis of COPD should not preclude treatment with beta-blockers, as previous concerns likely over-stated risk.

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Effects of metoprolol and carvedilol on pre-existing and new onset diabetes in patients with chronic heart failure: data from the Carvedilol Or Metoprolol European Trial (COMET)

Heart ◽

10.1136/hrt.2006.092379 ◽

2007 ◽

Vol 93 (8) ◽

pp. 968-973 ◽

Cited By ~ 98

Author(s):

C. Torp-Pedersen ◽

M. Metra ◽

A. Charlesworth ◽

P. Spark ◽

M. A. Lukas ◽

...

Keyword(s):

Heart Failure ◽

Chronic Heart Failure ◽

Failure Data ◽

Onset Diabetes ◽

European Trial ◽

New Onset

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P3538Effect of beta-blockers on mortality in heart failure with mid-range and preserved ejection fraction: a meta-analysis

European Heart Journal ◽

10.1093/eurheartj/ehz745.0401 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

H Fukuta ◽

N Ohte

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Beta Blockers ◽

Meta Analysis ◽

Small Sample ◽

Control Group ◽

Forest Plot ◽

Preserved Ejection Fraction ◽

Risk Of Mortality ◽

Reduced Risk

Abstract Background Despite the high mortality rate, there is no established therapy to improve survival in heart failure with mid-range ejection fraction (HFmrEF) or in heart failure with preserved ejection fraction (HFpEF). An individual patient-level analysis of major randomized controlled trials (RCTs) conducted by the Beta-Blockers in Heart Failure Collaborative Group (BB-HF) did not show clear mortality benefit of beta-blockers (BBs) in HFmrEF or HFpEF. However, due to the strict enrollment criteria, the patients who participated in these trials might represent a selected group of patients that is poorly representative of patients treated in routine clinical practice. In contrast, clinical characteristics of real-world patients are similar to those of patients enrolled in observational cohort studies (OCSs). Although many OCSs have examined the prognostic effect of BBs in HFmrEF/HFpEF, results are inconsistent due to limited power with small sample sizes and/or inadequate adjustment for known prognostic factors. Purpose We aimed to conduct a meta-analysis of OCSs and RCTs to determine the effect of BBs on mortality in HFmrEF/HFpEF. Methods A search of MEDLINE and EMBASE was conducted in November 2018. Clinical studies reporting the outcome of mortality for HF patients with EF≥0.40, being assigned to BB treatment and non-BB control group, were included. Results Seven OCSs with propensity score (PS) analysis (16,295 patients), 6OCSs without PS analysis (15,275 patients), and 4RCTs (1222 patients) were included for this meta-analysis. Forest plot of the effect of BBs on mortality is shown in Figure 1. Use of BBs was associated with reduced risk of mortality in the pooled analysis of OCSs with PS analysis (RR [95% CI] = 0.83 [0.74–0.92], P<0.001) and in that of OCSs without PS analysis (0.70 [0.52–0.94], P<0.05), but not in that of RCTs (0.88 [0.62–1.24], P=0.45). Overall, use of BBs was associated with reduced risk of mortality (RR [95% CI] = 0.82 [0.75–0.89], P<0.001). No evidence of publication bias was found either in visual inspection of funnel plots or using the Egger test (P>0.1). Figure 1 Conclusions Our meta-analysis showed that treatment with BBs for the HF patients with EF≥0.40 was associated with reduced risk of mortality. Our findings emphasize the importance of conducting new well-designed studies such as registry-based RCTs to confirm our observed potential survival benefit of BBs in HFmrEF or HFpEF.

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38 Comparison between patients with de novo acute heart failure and acute decompensation of chronic heart failure: data from the Italian Survey of acute heart failure

European Journal of Heart Failure Supplements ◽

10.1016/s1567-4215(06)80004-4 ◽

2006 ◽

Vol 5 (1) ◽

pp. 2-2

Author(s):

G CACCIATORE ◽

M PORCU ◽

A MAGGIONI ◽

D LUCCI ◽

F OLIVA ◽

...

Keyword(s):

Heart Failure ◽

Chronic Heart Failure ◽

Acute Heart Failure ◽

De Novo ◽

Failure Data ◽

Italian Survey ◽

Acute Decompensation

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588 The prognostic role of anemia in acute heart failure. Data from the Italian survey on acute heart failure

European Journal of Heart Failure Supplements ◽

10.1016/s1567-4215(06)80385-1 ◽

2006 ◽

Vol 5 (1) ◽

pp. 134-134

Author(s):

L SCELSI ◽

L TAVAZZI ◽

A MAGGIONI ◽

D LUCCI ◽

G CACCIATORE ◽

...

Keyword(s):

Heart Failure ◽

Acute Heart Failure ◽

Prognostic Role ◽

Failure Data ◽

Italian Survey

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Understanding Terminal Decline in Cognition and Risk of Death

European Psychologist ◽

10.1027/1016-9040.11.3.164 ◽

2006 ◽

Vol 11 (3) ◽

pp. 164-171 ◽

Cited By ~ 16

Author(s):

Patrick Rabbitt ◽

Mary Lunn ◽

Danny Wong

Keyword(s):

Risk Factors ◽

Longitudinal Study ◽

Test Scores ◽

Intelligence Test ◽

Practice Effects ◽

Risk Of Death ◽

Risk Of Mortality ◽

Impending Death ◽

Intelligence Test Scores ◽

Reduced Risk

There is new empirical evidence that the effects of impending death on cognition have been miscalculated because of neglect of the incidence of dropout and of practice gains during longitudinal studies. When these are taken into consideration, amounts and rates of cognitive declines preceding death and dropout are seen to be almost identical, and participants aged 49 to 93 years who neither dropout nor die show little or no decline during a 20-year longitudinal study. Practice effects are theoretically informative. Positive gains are greater for young and more intelligent participants and at all levels of intelligence and durations of practice; declines in scores of 10% or more between successive quadrennial test sessions are risk factors for mortality. Higher baseline intelligence test scores are also associated with reduced risk of mortality, even when demographics and socioeconomic advantage have been taken into consideration.

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