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Beta-blocker Use an...
Beta-blocker Use and 30-day All-cause Readmission in Medicare Beneficiaries with Systolic Heart Failure
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Bhatia, V. (author)
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Bajaj, N. S. (author)
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Sanam, K. (author)
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Hashim, T. (author)
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Morgan, C. J. (author)
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Prabhu, S. D. (author)
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Fonarow, G. C. (author)
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Deedwania, P. (author)
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Butler, J. (author)
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Carson, P. (author)
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Love, T. E. (author)
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Kheirbek, R. (author)
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Aronow, W. S. (author)
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Anker, S. D. (author)
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- Waagstein, Finn, 1938 (author)
- Gothenburg University,Göteborgs universitet,Institutionen för medicin,Institute of Medicine
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Fletcher, R. (author)
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Allman, R. M. (author)
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Ahmed, A. (author)
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(creator_code:org_t)
- Elsevier BV, 2015
- 2015
- English.
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In: American Journal of Medicine. - : Elsevier BV. - 0002-9343. ; 128:7, s. 715-721
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https://europepmc.or...
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https://gup.ub.gu.se...
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Abstract
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- BACKGROUND: Beta-blockers improve outcomes in patients with systolic heart failure. However, it is unknown whether their initial negative inotropic effect may increase 30-day all-cause readmission, a target outcome for Medicare cost reduction and financial penalty for hospitals under the Affordable Care Act. METHODS: Of the 3067 Medicare beneficiaries discharged alive from 106 Alabama hospitals (1998-2001) with a primary discharge diagnosis of heart failure and ejection fraction <45%, 2202 were not previously on beta-blocker therapy, of which 383 received new discharge prescriptions for beta-blockers. Propensity scores for beta-blocker use, estimated for each of the 2202 patients, were used to assemble a matched cohort of 380 pairs of patients receiving and not receiving beta-blockers who were balanced on 36 baseline characteristics (mean age 73 years, mean ejection fraction 27%, 45% women, 33% African American). RESULTS: Beta-blocker use was not associated with 30-day all-cause readmission (hazard ratio [HR] 0.87; 95% confidence interval [CI], 0.64-1.18) or heart failure readmission (HR 0.95; 95% CI, 0.57-1.58), but was significantly associated with lower 30-day all-cause mortality (HR 0.29; 95% CI, 0.12-0.73). During 4-year postdischarge, those in the beta-blocker group had lower mortality (HR 0.81; 95% CI, 0.67-0.98) and combined outcome of all-cause mortality or all-cause readmission (HR 0.87; 95% CI, 0.74-0.97), but not with all-cause readmission (HR 0.89; 95% CI, 0.76-1.04). CONCLUSIONS: Among hospitalized older patients with systolic heart failure, discharge prescription of beta-blockers was associated with lower 30-day all-cause mortality and 4-year combined death or readmission outcomes without higher 30-day readmission. Published by Elsevier Inc.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)
Keyword
- Beta-blockers
- Hospitalization
- Older adults
- Readmission
- Systolic heart failure
- CONVERTING ENZYME-INHIBITORS
- RENIN-ANGIOTENSIN INHIBITION
- PRESERVED
- EJECTION FRACTION
- CHRONIC KIDNEY-DISEASE
- ATRIAL-FIBRILLATION
- TRIAL
- MORTALITY
- THERAPY
- CARVEDILOL
- PROGRAM
- Medicine
- General & Internal
Publication and Content Type
- ref (subject category)
- art (subject category)
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- By the author/editor
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Bhatia, V.
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Bajaj, N. S.
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Sanam, K.
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Hashim, T.
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Morgan, C. J.
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Prabhu, S. D.
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show more...
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Fonarow, G. C.
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Deedwania, P.
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Butler, J.
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Carson, P.
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Love, T. E.
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Kheirbek, R.
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Aronow, W. S.
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Anker, S. D.
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Waagstein, Finn, ...
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Fletcher, R.
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Allman, R. M.
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Ahmed, A.
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show less...
- About the subject
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Cardiac and Card ...
- Articles in the publication
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American Journal ...
- By the university
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University of Gothenburg