Key result
Initiating beta-blockers at a dose higher than guideline recommendations was associated with a significantly higher risk of dose reduction or withdrawal during hospitalization (HR 1.78).
Why the study?
To evaluate guideline adherence of beta-blocker initiating dose and determine whether adherence impacts in-hospital outcomes in Chinese patients hospitalized with HFrEF.
Does a non-adherent initiating dose of beta-blockers increase the risk of adverse events or dose reduction/withdrawal in hospitalized patients with HFrEF?
Cohort (n=1,104)
No
Does a non-adherent initiating dose of beta-blockers increase the risk of adverse events or dose reduction/withdrawal in hospitalized patients with HFrEF?
Initiating beta-blockers at doses higher than guideline recommendations (>1/8 target dose) in hospitalized HFrEF patients is common and is associated with an increased risk of subsequent dose reduction or withdrawal.
Caution advised with higher-than-recommended initiating doses in hospitalized HFrEF; hypothesis-generating for guideline-adherent titration strategies.
Background: We aim to investigate the guideline adherence of β-blocker (BB) initiating dose in Chinese hospitalized patients with heart failure with reduced ejection fraction (HFrEF) and whether the adherence affected the in-hospital outcomes. Methods: This was a retrospective study of patients hospitalized with HFrEF who had initiated BBs during their hospitalization. We defined adherence to clinical practice guidelines as initiating BB with standard dose and non-adherence to guidelines if otherwise, and examined the association between adherence to guidelines and in-hospital BB-related adverse events. Subgroup analyses based on sex, age, coronary heart disease, and hypertension were performed. Results: Among 1,104 patients with HFrEF initiating BBs during hospitalization (median length of hospitalization, 12 days), 304 (27.5%) patients received BB with non-adherent initiating dose. This non-adherence was related to a higher risk (hazard ratio [95% confidence interval]) of BB dose reduction or withdrawal (1.78 [1.42 to 2.22], P < 0.001), but not significantly associated with risks of profound bradycardia, hypotension, cardiogenic shock requiring intravenous inotropes, and severe bronchospasm requiring intravenous steroid during hospitalization. Conclusion: This study identified that over a fourth of patients had received BBs with an initiating dose that was not adherent to guidelines in Chinese hospitalized patients with HFrEF, and this non-adherence was associated with BB dose reduction or withdrawal during hospitalization.
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Zhou et al. (2021) conducted a cohort in Heart failure with reduced ejection fraction (HFrEF) (n=1,104). Non-adherent initiating dose of beta-blockers (>1/8 target dose) vs. Adherent initiating dose of beta-blockers (≤1/8 target dose) was evaluated on Beta-blocker dose reduction or withdrawal during hospitalization (HR 1.78, 95% CI 1.42 to 2.22, p=<0.001). Initiating beta-blockers at a dose higher than guideline recommendations was associated with a significantly higher risk of dose reduction or withdrawal during hospitalization (HR 1.78).
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