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Betablockers are safe and effective in elderly patients with heart failure, a major new placebo-controlled trial reveals.
The SENIORS study found the
betabetablocker nebivolol could reduce both cardiovascular admissions and deaths by around 12 per cent in patients over the age of 70.
GPs have been reluctant to use
betablockers in elderly patients because of doubts over evidence and safety fears, although the over-70s are the highest risk group for heart failure.
But the researchers, based in the UK and at centres in Canada, Australia and across Europe, said their study extended the evidence for their use to a 'broad range of elderly patients with heart failure', including those with mild left ventricular dysfunction or preserved ventricular dysfunction.
Professor Richard Hobbs, chair
of the Primary Care Cardiovascular Society, warned GPs were often reluctant to prescribe betablockers because they had been trained to believe they were contraindicated in heart failure.
'There are also practical problems in terms of having to introduce
betablockers slowly and titrate up slowly, which makes them more difficult to use,' he added.
During the trial 2,128 patients with an average age of 76 were
randomly assigned to nebivolol or placebo and followed up for an average of 21 months.
Over this period, 31.1 per cent of patients on nebivolol died or were admitted to hospital with a cardiovascular event, compared with 35.3 per cent on placebo. And 15.8 per cent of patients on nebivolol died compared with 18.1 per cent of controls.
Professor Hobbs said there was often a delay between evidence for an intervention and increased uptake.
But he added: 'I think we will see a gradual increase in utilisation.'
·NICE recommends betablockers for heart failure but makes no special provision for elderly patients. GPs are underusing betablockers because of a perceived risk of side-effects in patients with occlusive arterial disease, a new study suggests. A cross-sectional study in the International Journal of Clinical Practice found that 80 per cent of UK GPs would not prescribe betablockers in peripheral vascular disease.
The study authors concluded patients often had a 'clear indication' for betablockers.
By Cato Pedder