Atenolol Associated With Mortality Benefit For Heart Failure

These US authors compared mortality associated with different beta-blockers following hospitalization for heart failure between 2001 and 2003. Longitudinal exposure to beta-blockers was ascertained from pharmacy databases. Patient characteristics and other medication use were identified from administrative, hospitalization, outpatient, and pharmacy databases. Death was identified from administrative, state mortality, and Social Security Administration databases.

They found: "Among 11 326 adults surviving a hospitalization for heart failure, 7976 received beta-blockers (atenolol 38.5%, metoprolol tartrate 43.2%, carvedilol 11.6%, and other 6.7%) during follow-up. The rate (per 100 person-years) of death during the 12 months after discharge varied by exposure and type of beta-blocker (atenolol 20.1, metoprolol tartrate 22.8, carvedilol 17.7, and no beta-blockers 37.0). After adjustment for confounders and the propensity to receive carvedilol, the risk of death compared with atenolol was higher for metoprolol tartrate (adjusted HR 1.16) and no beta- blockers (HR 1.63) but was not significantly different for carvedilol (HR, 1.16)."

The authors concluded: "Compared with atenolol, the adjusted risks of death were slightly higher with shorter-acting metoprolol tartrate but did not significantly differ for carvedilol in adults with heart failure. The results should be interpreted cautiously and they suggest the need for randomized trials within real-world settings comparing a broader spectrum of beta-blockers for heart failure."

Practice Pearl:
Atenolol is an inexpensive generic that compares well with other beta-blockers regarding its associated mortality benefit for patients with heart failure.

Arch Intern Med 168(22):2415-2421, 8/22 December 2008 - Comparative Effectiveness of Different Beta-Adrenergic Antagonists on Mortality Among Adults With Heart Failure in Clinical Practice. Alan S. Go, Jingrong Yang, Jerry H. Gurwitz, John Hsu, Kimberly Lane, Richard Platt.