35 research outputs found
Long-Term Mortality Associated With Use of Carvedilol Versus Metoprolol in Heart Failure Patients With and Without Type 2 Diabetes:A Danish Nationwide Cohort Study
BACKGROUND: Carvedilol may have favorable glycemic properties compared with metoprolol, but it is unknown if carvedilol has mortality benefit over metoprolol in patients with type 2 diabetes (T2D) and heart failure with reduced ejection fraction (HFrEF). METHODS AND RESULTS: Using Danish nationwide databases between 2010 and 2018, we followed patients with newâonset HFrEF treated with either carvedilol or metoprolol for allâcause mortality until the end of 2018. Followâup started 120Â days after initial HFrEF diagnosis to allow initiation of guidelineâdirected medical therapy. There were 39Â 260 patients on carvedilol or metoprolol at baseline (mean age 70.8Â years, 35% women), of which 9355 (24%) had T2D. Carvedilol was used in 2989 (32%) patients with T2D and 10Â 411 (35%) of patients without T2D. Users of carvedilol had a lower prevalence of atrial fibrillation (20% versus 35%), but other characteristics appeared wellâbalanced between the groups. Totally 11Â 306 (29%) were deceased by the end of followâup. We observed no mortality differences between carvedilol and metoprolol, multivariableâadjusted hazard ratio (HR) 0.97 (0.90â1.05) in patients with T2D versus 1.00 (0.95â1.05) for those without T2D, P for difference =0.99. Rates of newâonset T2D were lower in users of carvedilol versus metoprolol; age, sex, and calendar year adjusted HR 0.83 (0.75â0.91), P<0.0001. CONCLUSIONS: In a contemporary clinical cohort of HFrEF patients with and without T2D, carvedilol was not associated with a reduction in longâterm mortality compared with metoprolol. However, carvedilol was associated with lowered risk of newâonset T2D supporting the assertion that carvedilol has a more favorable metabolic profile than metoprolol
Importance of diagnostic setting in determining mortality in patients with new-onset heart failure: temporal trends in Denmark 1997â2017
Aim:
To investigate temporal trends in inpatient vs. outpatient diagnosis of new-onset heart failure (HF) and the subsequent risk of death and hospitalization.
Methods and results:
Using nationwide registers, 192â581 patients with a first diagnosis of HF (1997â2017) were included. We computed incidences of HF, age-standardized mortality rates, and absolute risks (ARs) of death and hospitalization (accounting for competing risk of death) to understand the importance of the diagnosis setting in relation to subsequent mortality and hospitalization. The overall incidence of HF was approximately the same (170/100â000 persons) every year during 1997â2017. However, in 1997, 77% of all first diagnoses of HF were made during a hospitalization, whereas the proportion was 39% in 2017. As inpatient diagnoses decreased, outpatient diagnoses increased from 23% to 61%. Outpatients had lower mortality and hospitalization rates than inpatients throughout the study period, although the 1-year age-standardized mortality rate decreased for each inpatient (24 to 14/100-person) and outpatient (11 to 7/100-person). One-year and five-year AR of death decreased by 11.1% and 17.0%, respectively, for all HF patients, while the risk of hospitalization for HF did not decrease significantly (1.13% and 0.96%, respectively).
Conclusion:
Between 1997 and 2017, HF changed from being primarily diagnosed during hospitalization to being mostly diagnosed in the outpatient setting. Outpatients had much lower mortality rates than inpatients throughout the study period. Despite a significant decrease in mortality risk for all HF patients, neither inpatients nor outpatients experienced a reduction in the risk of an HF hospitalization