The association between beta-blocker therapy and mortality in frail hip fracture patients: A Swedish retrospective cohort study

Abstract text (incl. references and figure legends)

Introduction

Hip fracture patients are a challenging cohort to manage owing to the high prevalence of frailty. While betablocker therapy(BBt) has shown a strong association with reduced postoperative mortality, the question remains if it is beneficial or detrimental to the most frail hip fracture patients. This study aims to examine how frailty, measured using the Orthopedic Hip Frailty Score(OFS), affects the association between beta-blocker therapy and 30day postoperative mortality.

Methods

This is a retrospective registerbased study where all adult patients in Sweden who suffered a traumatic hip fracture and underwent surgery between 2008 and 2017 were eligible for inclusion. The patients were stratified based on their OFS to assess the effect of BBt at each level. The primary outcome was 30days postoperative mortality. Inverse probability of treatment weighting(IPTW) was used to obtain unbiased estimates of average treatment effects.

Results

A total of 125,513 patients were included, of whom 39% had BBt. When IPTW was performed, there were no residual systematic differences in observed baseline characteristics between the BBt and nonBBt groups across all strata. This analysis found a stepwise increase in the absolute risk reduction(ARR) for each additional point on the OFS, with the largest effect being observed in patients with the highest OFS. Nonfrail patients (OFS 0) with BBt exhibited an ARR of 2.2% [95% confidence interval (CI): 2.0-2.4%; p<0.001], while the most frail patients (OFS 5) with BBt had an ARR of 24% (95% CI: 18-30%; p<0.001), compared to patients without BBt within the same stratum.

Conclusion

Betablocker therapy is associated with a reduced risk of 30mortality in frail hip fracture patients, with a greater effect being observed with higher Orthopedic Hip Frailty Scores. This pattern supports the hypothesis that betablocker therapy reduces mortality through the mitigation of the hyperadrenergic, which is detrimental to frail patients.

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Conflicts of Interest: The authors have no conflicts of interest to disclose.

Source of Funding/ Support: No financial support or funding were received for the presented work.