Continuation of beta-blockers after hospitalization for decompensated heart failure was associated with lower post-discharge mortality compared to no beta-blocker (HR 0.60; 95% CI 0.37-0.99; p=0.044).
Cohort (n=5,791)
Yes
Does continuation of beta-blocker therapy reduce post-discharge death and rehospitalization in patients hospitalized with decompensated systolic heart failure?
Continuing beta-blocker therapy during hospitalization for decompensated heart failure is associated with lower post-discharge mortality, whereas withdrawal is associated with increased mortality risk.
Hazard Ratio: 0.6 (95% CI 0.37–0.99)
p-value: p=0.044
OBJECTIVES: This study ascertains the relationship between continuation or withdrawal of beta-blocker therapy and clinical outcomes in patients hospitalized with systolic heart failure (HF). BACKGROUND: Whether beta-blocker therapy should be continued or withdrawn during hospitalization for decompensated HF has not been well studied in a broad cohort of patients. METHODS: The OPTIMIZE-HF (Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure) program enrolled 5,791 patients admitted with HF in a registry with pre-specified 60- to 90-day follow-up at 91 academic and community hospitals throughout the U.S. Outcomes data were prospectively collected and analyzed according to whether beta-blocker therapy was continued, withdrawn, or not started. RESULTS: Among 2,373 patients eligible for beta-blockers at discharge, there were 1,350 (56.9%) who were receiving beta-blockers before admission and continued on therapy, 632 (26.6%) newly started, 79 (3.3%) in which therapy was withdrawn, and 303 (12.8%) eligible but not treated. Continuation of beta-blockers was associated with a significantly lower risk and propensity adjusted post-discharge death (hazard ratio HR: 0.60; 95% confidence interval CI: 0.37 to 0.99, p = 0.044) and death/rehospitalization (odds ratio: 0.69; 95% CI: 0.52 to 0.92, p = 0.012) compared with no beta-blocker. In contrast, withdrawal of beta-blocker was associated with a substantially higher adjusted risk for mortality compared with those continued on beta-blockers (HR: 2.3; 95% CI: 1.2 to 4.6, p = 0.013), but with similar risk as HF patients eligible but not treated with beta-blockers. CONCLUSIONS: The continuation of beta-blocker therapy in patients hospitalized with decompensated HF is associated with lower post-discharge mortality risk and improved treatment rates. In contrast, withdrawal of beta-blocker therapy is associated with worse risk and propensity-adjusted mortality. (Organized Program To Initiate Lifesaving Treatment In Hospitalized Patients With Heart Failure OPTIMIZE-HF; NCT00344513).
“If you can, you always want to continue the beta blocker or the ACE inhibitor, because studies have shown us that the likelihood for patients to be on these medications 90 days later is dismal. But you also need to look at the patient. If the patient is in cardiogenic shock, their beta blocker should be stopped.”
Fonarow et al. (Tue,) conducted a cohort in Decompensated systolic heart failure (n=5,791). Continuation of beta-blocker therapy vs. No beta-blocker or withdrawal of beta-blocker was evaluated on Post-discharge death (HR 0.60, 95% CI 0.37 to 0.99, p=0.044). Continuation of beta-blockers after hospitalization for decompensated heart failure was associated with lower post-discharge mortality compared to no beta-blocker (HR 0.60; 95% CI 0.37-0.99; p=0.044).