Safety of Inpatient and Outpatient Beta Blocker Initiation in Pediatric Heart Failure

Beta-blockers (BB) are a core treatment in adult heart failure (HF) guideline directed medical therapy with evidence of reductions in mortality and HF hospitalizations. The optimal timing of BB initiation in children remains difficult to determine due to possible hemodynamic effects. We sought to analyze outcomes of pediatric HF readmission or death within 30 days of discharge after ambulatory vs. inpatient BB initiation. This retrospective analysis utilized the Advanced Cardiac Therapies Improving Outcomes Network HF registry to compare outcomes in patients with BB initiation during inpatient or outpatient encounters. Patients were excluded if BB initiation occurred prior to admission. In total, 94 patients were started on BB therapy with 69 (73.4%) during inpatient admission and 25 while outpatient. There was no difference in age or cardiac diagnosis between groups with dilated cardiomyopathy being predominant in both groups (56.5% v 36%). Both groups had similar baseline EF (33% vs. 34%, p = 0.983) and NYHA classification at time of initiation with majority being NYHA 3 or 4 (66.1% v 62.5%). There was no difference (p = 0.278) in re-admission rate between those initiated on BB inpatient (n = 10; 14.5%) vs. those initiated on BB outpatient (n = 1; 4%). There were no deaths within 30 days of discharge in either group. Initiation of pediatric BB therapy in children admitted for HF appears to be safe in both the inpatient and outpatient setting with no difference in 30-day readmission or mortality using this dataset. Continued evaluation with a larger accrual of data will be important.