beta blocker treatment and other prognostic variables in patients with clinical evidence of heart failure after acute myocardial infarction: evidencefrom the AIRE study

Objectives-To examine clinical outcomes associated with optional beta block ade in a population of patients with evidence of heart failure after myocar dial infarction. Design and patients-Data from the acute infarction ramipril efficacy (AIRE) study were analysed retrospectively. At baseline 22.3% of the patients wer e receiving a beta blocker. To minimise confounding, beta blocker and diure tic treatments, presence of clinical signs of heart failure, left ventricul ar ejection fraction, and 16 other baseline clinical variables were simulta neously entered in a multivariate Cox regression model. In addition, the sa me analysis was repeated separately within a high and a low risk group of p atients, as defined according to the need for diuretic treatment. Results-beta Blocker treatment was an independent predictor of reduced risk of total mortality (hazard ratio 0.66, 95% confidence interval (CI) 0.48 t o 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-beta Blocker treatment is associated with improved outcomes in patients with clinical evidence of mild to moderate heart failure after myo cardial infarction. Most importantly, high risk patients with persistent he art failure appear to benefit at least as much as lower risk patients with transient heart failure.