Aim To study the efficacy and tolerability of β-blockade in elderly p atients with heart failure in the MERIT-HF study. Methods and results Cox proportional hazards model was used to calculate hazard ratios (HR) with 95%confidence inte rvals (CI). Risk reduction was defined as (1-HR). In patients ≥65 years total mortality was reduced by 37%(95%CI 17%to 52%; p=0.0008), sudden death by 43 %(95%CI 17%to 61%; p=0.0032), and death from worsening heart failure by 61% (95%CI 32%to 77%; p=0.0005). Hospitalisations for worsening heart failure was reduced by 36%(p=0.0006). Elderly patients with severe heart failure (NYHA cla ss III/IV with ejection fraction < 0.25; n=425), and patients above 75 years (n= 490) showed similar risk reductions. Metoprolol CR/XL was safe and well tolerate d both during initiating therapy and during long-term follow-up. Conclusions M etoprolol CR/XL was easily instituted, safe and well tolerated in elderly patien ts with systolic heart failure. The data suggest that these are the patients in whom treatment will have the great est impact as shown by number of lives saved and number of hospitalisations avoi ded. The time has come to overcome the barriers that physicians perceive to β- blocker treatment, and to provide it to the large number of elderly patients wit h heart failure in need of this therapy.
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