Limited alcohol consumption associated with longer survival in older adults with incident HF

Association of Alcohol Consumption After Development of Heart Failure With Survival Among Older Adults in the Cardiovascular Health Study

Literature - Sadhu JS, Novak E, Mukamal KJ et al. - JAMA Network Open. 2018;1(8):e186383

Introduction and methods

In contrast to conflicting data on the relationship between previous alcohol use and the development of heart failure (HF), there is a lack of data regarding the safety of alcohol consumption in patients after a new diagnosis of HF. Previous studies focusing on alcohol consumption in adults with HF were limited to subjects with prevalent disease [1-4], possibly leading to a survivor bias influencing the outcomes.

This subanalysis of the Cardiovascular Health Study (n=5888) therefore examined the association between alcohol consumption and survival following the diagnosis of HF in older adults. This prospective cohort study (January to September 2016) included 393 community-dwelling adults aged ≥65 years with incident HF, which had been diagnosed during the first 10 years of the Cardiovascular Health Study. After a baseline clinical examination, participants attended nine yearly clinic visits. An alcoholic beverage was defined as a: 12-oz beer, 6-oz glass of wine, or a shot (1.5 ounces) of liquor. Weekly alcohol consumption was self-reported. Eligible participants were classified as abstainer (never drinker, 42.7%), former drinker (24.4%), consumer of 1-7 drinks (28.5%), or consumer of ≥7 drinks (4.3%). With the exception of 22 participants, all died during follow-up.

Main results

The median survival after diagnosis of HF was 7.5 years (IQR: 4.3-10.9).
After multivariable adjustment, consumption of ≤7 drinks per week was associated with significantly longer survival following the diagnosis of HF, compared with abstinence (survival of an additional 383 days, 95%CI: 17-748; P=0.04).
A significant inverted U-shaped association between alcohol consumption and survival was seen. However, robustness was limited by the small number of individuals who consumed ≥7 drinks per week.
Multivariable model estimates of mean time from HF diagnosis to death were 2640 days (95%CI: 1967-3313) for never drinkers, 3046 days (95%CI: 2372-3719) for consumers of ≤7 drinks per week, and 2806 days (95%CI: 1879-3734) for consumers of ≥7 drinks per week (P=0.02).

Conclusion

This unique prospective cohort study in community-dwelling older adults with HF, showed that alcohol consumption of ≤7 drinks per week after the diagnosis of HF was associated with longer survival, compared to long-term abstinence. Further research should focus on optimal levels of alcohol consumption in adults with HF and determine whether this differs by age, sex, left ventricular ejection fraction, or cause of HF.

References

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