Heart 1999;81:25-32 ( January )
Blocker treatment and other prognostic variables in patients
with clinical evidence of heart failure after acute myocardial
infarction: evidence from the AIRE study
a Institute for
Cardiovascular Research, University of Leeds, Leeds LS2 9JT, UK, b Subunit for Medical Statistics, University of
Leeds
Correspondence to: Dr Hall.
Accepted for publication 29 July 1998
Objectives
To
examine clinical outcomes associated with optional 
blockade in a
population of patients with evidence of heart failure after myocardial infarction.
Design and
patientsData from the acute infarction ramipril
efficacy (AIRE) study were analysed retrospectively. At baseline 22.3%
of the patients were receiving a blocker. To minimise confounding,
blocker and diuretic treatments, presence of clinical signs of
heart failure, left ventricular ejection fraction, and 16 other
baseline clinical variables were simultaneously entered in a
multivariate Cox regression model. In addition, the same analysis was
repeated separately within a high and a low risk group of patients, as
defined according to the need for diuretic treatment.
Results Blocker
treatment was an independent predictor of reduced risk of total
mortality (hazard ratio 0.66, 95% confidence interval (CI) 0.48 to
0.90) and progression to severe heart failure (0.58, 95% CI 0.40 to
0.83) for the entire study population. There were similar findings in
high risk patients requiring diuretics (0.59, 95% CI 0.40 to 0.86; and
0.58, 95% CI 0.38 to 0.89).
Conclusions
Blocker treatment is associated with improved outcomes in patients with
clinical evidence of mild to moderate heart failure after myocardial
infarction. Most importantly, high risk patients with persistent heart
failure appear to benefit at least as much as lower risk patients with
transient heart failure.
blockers
© 1999 by Heart
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