Sex-dependent changes in physical, mental, and quality of life outcomes in metoprolol-treated Chinese chronic heart failure patients

Wu, Liyong; Zhang, Qian; Shu, Qiuhong; Zhang, Ran; Meng, Yong

doi:10.1097/md.0000000000018331

Cited by 7 publications

(10 citation statements)

References 53 publications

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“…However, there have been concerns of psychiatric adverse events during β-blocker use [ 3 ], and sleep disturbances, psychoses, and depression are listed as potential adverse events in the summary of product characteristics for β-blockers [ 4 ]. This is supported by observational studies that found an increased risk of depression for patients using β-blockers [ 5 – 10 ]. Several case reports have linked β-blockers to psychosis and delirium but there are no larger studies on these outcomes.…”

Section: Introductionmentioning

confidence: 68%

“…Observational studies have also found an increased risk of suicide among individuals taking β-blockers as compared to controls [ 11 – 13 ]. However, there is contrasting evidence; β-blockers have been associated with decreases in depression and anxiety in other observational investigations [ 9 , 10 , 14 – 19 ] and a randomised controlled trial [ 20 ]. In addition, there are several observational studies [ 2 , 3 , 21 – 25 ] and randomised controlled trials [ 26 – 30 ] showing no associations with psychiatric events.…”

Section: Introductionmentioning

confidence: 99%

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Associations between β-blockers and psychiatric and behavioural outcomes: A population-based cohort study of 1.4 million individuals in Sweden

et al. 2023

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Background β-blockers are widely used for treating cardiac conditions and are suggested for the treatment of anxiety and aggression, although research is conflicting and limited by methodological problems. In addition, β-blockers have been associated with precipitating other psychiatric disorders and suicidal behaviour, but findings are mixed. We aimed to examine associations between β-blockers and psychiatric and behavioural outcomes in a large population-based cohort in Sweden. Methods and findings We conducted a population-based longitudinal cohort study using Swedish nationwide high-quality healthcare, mortality, and crime registers. We included 1,400,766 individuals aged 15 years or older who had collected β-blocker prescriptions and followed them for 8 years between 2006 and 2013. We linked register data on dispensed β-blocker prescriptions with main outcomes, hospitalisations for psychiatric disorders (not including self-injurious behaviour or suicide attempts), suicidal behaviour (including deaths from suicide), and charges of violent crime. We applied within-individual Cox proportional hazards regression to compare periods on treatment with periods off treatment within each individual in order to reduce possible confounding by indication, as this model inherently adjusts for all stable confounders (e.g., genetics and health history). We also adjusted for age as a time-varying covariate. In further analyses, we adjusted by stated indications, prevalent users, cardiac severity, psychiatric and crime history, individual β-blockers, β-blocker selectivity and solubility, and use of other medications. In the cohort, 86.8% (n = 1,215,247) were 50 years and over, and 52.2% (n = 731,322) were women. During the study period, 6.9% (n = 96,801) of the β-blocker users were hospitalised for a psychiatric disorder, 0.7% (n = 9,960) presented with suicidal behaviour, and 0.7% (n = 9,405) were charged with a violent crime. There was heterogeneity in the direction of results; within-individual analyses showed that periods of β-blocker treatment were associated with reduced hazards of psychiatric hospitalisations (hazard ratio [HR]: 0.92, 95% confidence interval [CI]: 0.91 to 0.93, p < 0.001), charges of violent crime (HR: 0.87, 95% CI: 0.81 to 0.93, p < 0.001), and increased hazards of suicidal behaviour (HR: 1.08, 95% CI: 1.02 to 1.15, p = 0.012). After stratifying by diagnosis, reduced associations with psychiatric hospitalisations during β-blocker treatment were mainly driven by lower hospitalisation rates due to depressive (HR: 0.92, 95% CI: 0.89 to 0.96, p < 0.001) and psychotic disorders (HR: 0.89, 95% CI: 0.85 to 0.93, p < 0.001). Reduced associations with violent charges remained in most sensitivity analyses, while associations with psychiatric hospitalisations and suicidal behaviour were inconsistent. Limitations include that the within-individual model does not account for confounders that could change during treatment, unless measured and adjusted for in the model. Conclusions In this population-wide study, we found no consistent links between β-blockers and psychiatric outcomes. However, β-blockers were associated with reductions in violence, which remained in sensitivity analyses. The use of β-blockers to manage aggression and violence could be investigated further.

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Section: Introductionmentioning

confidence: 68%

Section: Introductionmentioning

confidence: 99%

Associations between β-blockers and psychiatric and behavioural outcomes: A population-based cohort study of 1.4 million individuals in Sweden

et al. 2023

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“…We assume that selective beta-blockers could not only improve energy metabolism and reduce hemodynamic alterations and proarrhythmogenic potential induced by excessive sympathetic excitation 311 but they might be more effective in alleviating mental stress and anxiety disorders. Indeed, selective beta-blockers decreased symptoms of anxiety in patients with chronic heart failure (metoprolol), 81 mitral valve prolapse syndrome (celiprolol) 70 and anxiety-related mental health problems (atenolol). 82 Prazosin, the alpha-1 antagonist, is currently used more often for indications other than hypertension.…”

Section: Discussionmentioning

confidence: 99%

“…The use of propranolol after experiencing 79 or recalling 80 traumatic events reduced the symptoms of anxiety and PTSD. Metoprolol lowered the anxiety score in chronic heart failure patients 81 and atenolol reduced PTSD and anxiety symptoms in patients with mental health problems 82 . There is even some evidence of an anxiolytic effect of beta‐blockers in healthy individuals 83 (Table 1).…”

Section: Cardiovascular Drugs and Anxietymentioning

confidence: 99%

Cardiovascular therapeutics: A new potential for anxiety treatment?

Repova

Aziriova

Krajcirovicova

et al. 2022

Medicinal Research Reviews

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Besides the well-recognized risk factors, novel conditions increasing cardiovascular morbidity and mortality are emerging.Undesirable emotions and behavior such as anxiety and depression, appear to participate in worsening cardiovascular pathologies. On the other hand, deteriorating conditions of the heart and vasculature result in disturbed mental and emotional health. The pathophysiological background of this bidirectional

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“…Minnesota Living with Heart Failure Questionnaire (MLHFQ) is the most used instrument to evaluate the quality of life in patients with heart failure [ 9 – 11 ]. MLHFQ captures the symptom of HF and patients’ concerns, such as swelling, hospitalization, breathing, and so on.…”

Section: Introductionmentioning

confidence: 99%

Mapping the Minnesota Living with Heart Failure Questionnaire (MLHFQ) to SF-6Dv2 in Chinese patients with heart failure

Cong

Zhu

et al. 2022

Health Qual Life Outcomes

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Purpose Mapping the Minnesota Living with Heart Failure Questionnaire (MLHFQ) to SF-6Dv2 in Chinese patients with chronic heart failure, and to obtain the health utility value for health economic assessment. Methods Four statistical algorithms, including ordinary least square method (OLS), Tobit model, robust MM estimator (MM) and censored least absolute deviations (CLAD), were used to establish the alternative model. Models were validated by using a tenfold cross-validation technique. The mean absolute error (MAE) and root mean square error (RMSE) were used to evaluate the prediction performance of the model. The Spearman correlation coefficient and Intraclass Correlation Coefficients (ICC) were used to examine the relationship between the predicted and observed SF-6Dv2 values. Results A total of 195 patients with chronic heart failure were recruited from 3 general hospitals in Beijing. The MLHFQ summary score and domain scores of the study sample were negatively correlated with SF-6Dv2 health utility value. The OLS regression model established based on the MLHFQ domain scores was the optimal fitting model and the predicted value was highly positively correlated with the observed value. Conclusion The MLHFQ can be mapped to SF-6Dv2 by OLS, which can be used for health economic assessment of cardiovascular diseases such as chronic heart failure.

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Sex-dependent changes in physical, mental, and quality of life outcomes in metoprolol-treated Chinese chronic heart failure patients

Cited by 7 publications

References 53 publications

Associations between β-blockers and psychiatric and behavioural outcomes: A population-based cohort study of 1.4 million individuals in Sweden

Associations between β-blockers and psychiatric and behavioural outcomes: A population-based cohort study of 1.4 million individuals in Sweden

Cardiovascular therapeutics: A new potential for anxiety treatment?

Mapping the Minnesota Living with Heart Failure Questionnaire (MLHFQ) to SF-6Dv2 in Chinese patients with heart failure

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