Abstract 12707: The Association Between Beta-Blockers and Outcomes in Patients With Heart Failure and Alzheimer's Disease and Related Dementias

Abstract

Introduction: Contemporary HFrEF patients are older and have a higher prevalence of cognitive impairment compared to those studied in the original beta-blocker (BB) trials. While BB decrease mortality and morbidity in HFrEF, their use has been linked to higher fall risk and possibly acceleration of cognitive decline among older adults with Alzheimer’s Disease and Related Dementias (ADRD). The risk/benefit trade-off of beta blocker (BB) use in patients with HFrEF and dementia has not been examined. Methods: Using a 100% sample of patients enrolled in Medicare A, B and a 40% sample of D with ≥1 hospitalization for HFrEF between 2008 and 2018, we created a cohort of beneficiaries with HFrEF but no prior diagnosis of ADRD. We then subset to the population to those that developed ADRD in the year after their HFrEF hospitalization and compared BB use pre/post ADRD diagnosis and is association with outcomes using a time varying exposure. Results: The highest 1-year survival after ADRD diagnosis was observed among those continued on BB after ADRD diagnosis, regardless of whether they were on BB before (HR 0.427, 95% CI 0.406, 0.465, p<0.001) the ADRD diagnosis or not (HR=0.629, 95% CI 00.545, 0.670, p<0.001; Figure 1 ). The poorest survival was observed among those who had their BB stopped after their ADRD diagnosis (HR=2.34, 95% CI 2.15, 2.46). Conclusion: Among patients with HFrEF, stopping BB therapy after a diagnosis of ADRD is associated with the poorest survival. The best survival was observed among those continued on BB after ADRD diagnosis. Therefore, unless there is a clear clinical indication, BB therapy should not be stopped after a diagnosis of ADRD.