In patients with HFpEF and atrial fibrillation, beta-blocker treatment at discharge was associated with an 82% reduction in 60-day heart failure rehospitalization among those with a discharge heart rate over 75 bpm.
Cohort (n=687)
Yes
Does beta-blocker treatment at discharge reduce 60-day heart failure rehospitalization or mortality in patients with HFpEF and AF?
Beta-blocker therapy at discharge is associated with reduced 60-day heart failure rehospitalization in patients with HFpEF and AF who have a discharge heart rate over 75 bpm.
Effect estimate: HR 0.18 (95% CI 0.04-0.81)
Absolute Event Rate: 2.5% vs 13.7%
p-value: p=0.026
Background and Objectives: Beta-blockers (BBs) improve prognosis in heart failure (HF), which is mediated by lowering heart rate (HR). However, HR has no prognostic implication in atrial fibrillation (AF) and also BBs have not been shown to improve prognosis in heart failure with preserved ejection fraction (HFpEF) with AF. This study assessed the prognostic implication of BB in HFpEF with AF according to discharge HR. Methods: From the Korean Acute Heart Failure Registry, 687 patients with HFpEF and AF were selected. Study subjects were divided into 4 groups based on 75 beats per minute (bpm) of HR at discharge and whether or not they were treated with BB at discharge. Results: Of the 687 patients with HFpEF and AF, 128 (36.1%) were in low HR group and 121 (36.4%) were in high HR group among those treated with BB at discharge. In high HR group, HR at discharge was significantly faster in BB non-users (85.5±9.1 bpm vs. 89.2±12.5 bpm, p=0.005). In the Cox model, BB did not improve 60-day rehospitalization (hazard ratio, 0.93; 95% confidence interval 95% CI, 0.35-2.47) or mortality (hazard ratio, 0.77; 95% CI, 0.22-2.74) in low HR group. However, in high HR group, BB treatment at discharge was associated with 82% reduced 60-day HF rehospitalization (hazard ratio, 0.18; 95% CI, 0.04-0.81), but not with mortality (hazard ratio, 0.77; 95% CI, 0.20-2.98). Conclusions: In HFpEF with AF, in patients with HR over 75 bpm at discharge, BB treatment at discharge was associated with a reduced 60-day rehospitalization rate.
Kim et al. (Mon,) conducted a cohort in Heart failure with preserved ejection fraction (HFpEF) and atrial fibrillation (AF) (n=687). Beta-blockers vs. No beta-blockers was evaluated on 60-day heart failure rehospitalization in patients with discharge heart rate >75 bpm (HR 0.18, 95% CI 0.04-0.81, p=0.026). In patients with HFpEF and atrial fibrillation, beta-blocker treatment at discharge was associated with an 82% reduction in 60-day heart failure rehospitalization among those with a discharge heart rate over 75 bpm.