Calcium-channel blockers & heart failure: No harm, no benefit

Heart failure patients with preserved ejection fraction using calcium-channel blockers (CCBs) were no worse for taking them. But, they also didn’t experience much benefit either, according to a study published online Oct. 8 in Circulation: Heart Failure.

Researchers found that all-cause mortality or heart failure hospitalization occurred in 82 percent of patients receiving and 81 percent of patients not receiving CCBs at six-year follow-up.

Kanan Patel, MBBS, MPH, of the University of California, San Francisco, and colleagues used data from the OPTIMIZE-HF and Medicare databases to follow a matched cohort of 1,620 elderly patients with heart failure and preserved ejection fraction for six years. OPTIMIZE-AF is a national registry of hospitalized heart failure patients.

Half of these patients were prescribed CCBs following a heart failure discharge between March 2003 and December 2004. Reviewing all-cause mortality, heart failure hospitalization and all-cause hospitalization separately, Patel et al found patients had a 1.05, 1.05 and 1.03 risk, respectively, when taking CCBs.

Patel et al noted that their findings combined with those from prior studies on patients with heart failure but reduced ejection fraction appear to reveal that patients do no worse regardless of ejection fraction status when given CCBs.

They did, however, find some difference between patients taking amlodipine and non-amlodipine CCBs in the composite of all-cause mortality and heart failure hospitalization (hazard ratio 0.96 and 1.08 respectively), but not much.

“Hypertension is one of the leading causes of HFpEF [heart failure with preserved ejection fraction] in older adults and CCB is one of the commonly prescribed anti-hypertensive drugs,” wrote Patel et al. They noted that no evidence-based guidelines yet exist for use of CCBs by patients with heart failure and preserved ejection fraction. Physicians may, therefore, currently prescribe these drugs to control blood pressure and heart rate and attempt to improve outcomes for patients based on those symptoms.

“These findings suggest that the negative inotropic and chronotropic effects of CCBs had no negative association with outcomes in HFpEF,” they wrote.