Statin use and survival outcomes in elderly patients with heart failure.

Background:Coronary artery disease is a leading cause of heart failure. Statins are efficacious drugs for the primary and secondary prevention of coronary heart disease, but their value in persons with heart failure remains unknown. Methods:We performed a population-based retrospective cohort study involving the entire province of Ontario, Canada, restricting participants to those aged 66 to 85 years who were free of cancer and who survived at least 90 days following hospitalization for newly diagnosed heart failure. The primary study outcome was the risk of death from all causes, nonfatal acute myocardial infarction, or nonfatal stroke among persons newly dispensed statins (n=1146) relative to those who were not (n=27682). Results:Themeanageofallparticipantswas76.5years, and half were women. During the 7-year study period, death, acute myocardial infarction, or stroke occurred in 217statinrecipients(13.6per100person-years)vs12299 nonrecipients (21.8 per 100 person-years; adjusted hazard ratio [HR], 0.72; 95% confidence interval [CI], 0.630.83). Most of the benefit from statins was related to a reduction in all-cause mortality (adjusted HR, 0.67; 95% CI,0.57-0.78).Nosignificantreductionwasseenforsubsequent myocardial infarction (adjusted HR, 0.81; 95% CI,0.63-1.03)orstroke(adjustedHR,0.81;95%CI,0.531.25). Conclusions: Statin use is associated with a lower risk of death among seniors newly diagnosed as having congestive heart failure. While statin use has been previously shown to be efficacious in patients with coronary heartdiseaseandstroke,wecouldnotcontrolforallprognosticriskfactorsinthepresentstudy,includingleftventricular ejection fraction and serum lipid levels. Better evidence can direct clinicians about which patients with heart failure might benefit from these drugs. Arch Intern Med. 2005;165:62-67