Key result
Esmolol use in critically ill patients with a heart rate >100 beats/min was not significantly associated with 28-day mortality after propensity score matching (HR 0.84; 95% CI 0.65-1.08; p=0.167).
Why the study?
Esmolol is commonly used to control ventricular rate, but its association with mortality in critically ill patients required evaluation.
Does esmolol treatment reduce mortality in critically ill adult patients with a heart rate of over 100 beats/min during ICU stay?
Cohort (n=30,332)
Does esmolol treatment reduce mortality in critically ill adult patients with a heart rate of over 100 beats/min during ICU stay?
Hazard Ratio: 0.84 (95% CI 0.65–1.08)
p-value: p=0.167
In critically ill patients with tachycardia, esmolol use does not improve 28-day or 90-day mortality but is associated with an increased need for vasopressors.
Background and aims Esmolol is a common short-acting drug to control ventricular rate. This study aimed to evaluate the association between use of esmolol and mortality in critically ill patients. Methods This is a retrospective cohort study from MIMIC-IV database containing adult patients with a heart rate of over 100 beats/min during the intensive care unit (ICU) stay. Multivariable Cox proportional hazard models and logistic regression were used to explore the association between esmolol and mortality and adjust confounders. A 1:1 nearest neighbor propensity score matching (PSM) was performed to minimize potential cofounding bias. The comparison for secondary outcomes was performed at different points of time using an independent t-test. Results A total of 30,332 patients were reviewed and identified as critically ill. There was no significant difference in 28-day mortality between two groups before (HR = 0.90, 95% CI = 0.73-1.12, p = 0.343) and after PSM (HR = 0.84, 95% CI = 0.65-1.08, p = 0.167). Similar results were shown in 90-day mortality before (HR = 0.93, 95% CI = 0.75-1.14, p = 0.484) and after PSM (HR = 0.85, 95% CI = 0.67-1.09, p = 0.193). However, esmolol treatment was associated with higher requirement of vasopressor use before (HR = 2.89, 95% CI = 2.18-3.82, p < 0.001) and after PSM (HR = 2.66, 95% CI = 2.06-3.45, p < 0.001). Esmolol treatment statistically reduced diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate (all p < 0.001) and increased fluid balance at 24 hours ( p < 0.05) but did not significantly lower SBP ( p = 0.721). Patients in esmolol group showed no significant difference in lactate levels and daily urine output when compared with those in non-esmolol group when adjusted for confounders (all p > 0.05). Conclusion Esmolol treatment was associated with reduced heart rate and lowered DBP and MAP, which may increase vasopressor use and fluid balance at the timepoint of 24 hours in critically ill patients during ICU stay. However, after adjusting for confounders, esmolol treatment was not associated with 28-day and 90-day mortality.
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Liang et al. (2023) conducted a cohort in Critically ill patients with tachycardia (n=30,332). Esmolol vs. Non-esmolol group was evaluated on 28-day mortality (HR 0.84, 95% CI 0.65-1.08, p=0.167). Esmolol use in critically ill patients with a heart rate >100 beats/min was not significantly associated with 28-day mortality after propensity score matching (HR 0.84; 95% CI 0.65-1.08; p=0.167).
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