Elsevier

American Heart Journal

Volume 148, Issue 5, November 2004, Pages 915-920
American Heart Journal

Clinical investigation: congestive heart failure
Association between chronic heart failure and inhaled β-2-adrenoceptor agonists

https://doi.org/10.1016/j.ahj.2004.03.048Get rights and content

Abstract

Background

Recent reports suggest an association between β-agonists and the risk of incident chronic heart failure (CHF). We sought to examine the association between inhaled β-agonists and risk of incident and nonincident heart failure.

Methods

We performed a nested case-control study within the Ambulatory Care Quality Improvement Project (ACQUIP). Case subjects were defined as having had a hospitalization with a primary discharge diagnosis of CHF. Controls were randomly selected from the ACQUIP cohort. The exposure was the number of β-agonist canisters filled in the 90 days before an index date.

Results

After adjusting for potentially confounding factors, there appeared to be no association between the use of inhaled β-agonists and the risk of heart failure (1–2 canisters per month, OR 1.3 [95% CI 0.9, 1.8], ≥3 canisters per month, 1.1 [95% CI 0.8, 1.6]). However, among the cohort that had a history of CHF, there appeared to be a dose-response association between the number of inhaled β-agonists and the risk of hospitalization for chronic heart failure (1–2 canisters per month, adjusted OR 1.8 [95% CI 1.1, 3.0], ≥3 canisters per month, adjusted OR 2.1 [95% CI 1.2, 3.8]).

Conclusion

β-Agonists did not appear to be associated with incident heart failure but were associated with risk of CHF hospitalization among those subjects with a previous CHF diagnosis. Although a causal relationship cannot be inferred from these findings, further research is warranted to determine the safety and effectiveness of inhaled β-agonists for patients with CHF.

Section snippets

Methods

The data for this study were collected as part of the Ambulatory Care Quality Improvement Project (ACQUIP). ACQUIP was a multicenter, randomized, clinical trial designed to test whether monitoring patients' self-reported health and provision of regular reports to primary care clinicians improves clinical outcomes and patients' satisfaction. Details of the clinical trial have been described previously.19 The current analysis included those subjects who were enrolled at the inception of the

Discussion

The primary objective of this study was to examine the association between inhaled β-agonists and the risk of hospital admission for CHF. We found that subjects who had a previous diagnosis of CHF had a dose-dependent increase in risk for hospitalization, whereas those without this history did not. The increase in risk among patients with existing CHF was independent of history of COPD, steroid use, β-blocker use, ACE inhibitor use, myocardial ischemia, and cardiovascular risk factors. Although

References (28)

  • A. Hjalmarson et al.

    Effects of controlled-release metoprolol on total mortality, hospitalizations, and well-being in patients with heart failurethe Metoprolol CR/XL Randomized Intervention Trial in congestive heart failure (MERIT-HF)

    JAMA

    (2000)
  • S.S. Coughlin et al.

    Respiratory illness, beta-agonists, and risk of idiopathic dilated cardiomyopathythe Washington, DC, Dilated Cardiomyopathy Study

    Am J Epidemiol

    (1995)
  • E.M. Gilbert et al.

    beta-adrenergic receptor regulation and left ventricular function in idiopathic dilated cardiomyopathy

    Am J Cardiol

    (1993)
  • S.B. Liggett et al.

    The Ile164 beta2-adrenergic receptor polymorphism adversely affects the outcome of congestive heart failure

    J Clin Invest

    (1998)
  • Cited by (0)

    Funding for this project was provided through the Department of Veterans Affairs and Health Services Research and Development, SDR96-002, Ambulatory Care Quality Improvement Project (ACQUIP). Dr. Au was funded by a Department of Veterans Affairs Career Development Award.

    The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veteran Affairs.

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