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  • Title: β-blockade with nebivolol for prevention of acute ischaemic events in elderly patients with heart failure.
    Author: Ambrosio G, Flather MD, Böhm M, Cohen-Solal A, Murrone A, Mascagni F, Spinucci G, Conti MG, van Veldhuisen DJ, Tavazzi L, Coats AJ.
    Journal: Heart; 2011 Feb; 97(3):209-14. PubMed ID: 21138861.
    Abstract:
    OBJECTIVES: This subanalysis of the Study of the Effects of Nebivolol Intervention on Outcomes and Hospitalisation in Seniors with Heart Failure (SENIORS) investigates whether treatment with nebivolol, a β-blocker with nitric oxide-releasing properties, can provide additional benefits besides its effects on heart failure (HF), by reducing cardiac ischaemic events in patients with HF of ischaemic aetiology. DESIGN: A double-blind, randomised, placebo-controlled, multicentre trial of nebivolol in 2128 elderly patients. PATIENTS AND INTERVENTIONS: For this analysis, data were extracted for 2128 elderly (≥ 70 years) HF patients in whom coronary artery disease (CAD) was the underlying aetiology (68.2%; 717 placebo-treated patients and 735 assigned to nebivolol). MAIN OUTCOME MEASURES: The main endpoint was the composite of cardiac ischaemic events at 2 year follow-up: death/hospitalisation for myocardial infarction, unstable angina or sudden death, as originally identified in the case report form. RESULTS: At follow-up, nebivolol treatment was associated with a one-third reduction in the risk of ischaemic events, the composite endpoint occurring in 15.9% of placebo and 10.7% of nebivolol-treated patients (HR 0.68; 95% CI 0.51 to 0.90; p=0.008). This effect was independent of age, gender and ejection fraction. No difference in this composite endpoint was observed in the subgroup of patients of non-ischaemic aetiology. CONCLUSIONS: Nebivolol was effective in reducing cardiac ischaemic events in patients with HF of ischaemic aetiology. The prevention of ischaemic events can be an additional beneficial effect of β-blockade in HF patients with underlying CAD.
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