Key result
Admission beta-blocker use in ADHF is linked to ~59% lower in-hospital mortality.
Why the study?
It remained unclear whether beta-blocker use at hospital admission is associated with better in-hospital outcomes in patients with acute decompensated heart failure.
Does beta-blocker use at admission reduce in-hospital mortality in patients with acute decompensated heart failure?
Cohort (n=3,817)
Does beta-blocker use at admission reduce in-hospital mortality in patients with acute decompensated heart failure?
Odds Ratio: 0.41 (95% CI 0.27–0.6)
Absolute Event Rate: 4.4% vs 7.6%
p-value: p=<0.001
Beta-blocker use at admission in patients with acute decompensated heart failure is associated with significantly lower in-hospital mortality.
May support beta-blocker continuation in acute decompensated HF; hypothesis-generating and requires randomized confirmation.
Background It remains unclear whether beta‐blocker use at hospital admission is associated with better in‐hospital outcomes in patients with acute decompensated heart failure. Methods and Results We evaluated the factors independently associated with beta‐blocker use at admission, and the effect of beta‐blocker use at admission on in‐hospital mortality in 3817 patients with acute decompensated heart failure enrolled in the Kyoto Congestive Heart Failure registry. There were 1512 patients (39.7%) receiving, and 2305 patients (60.3%) not receiving beta‐blockers at admission for the index acute decompensated heart failure hospitalization. Factors independently associated with beta‐blocker use at admission were previous heart failure hospitalization, history of myocardial infarction, atrial fibrillation, cardiomyopathy, and estimated glomerular filtration rate <30 mL/min per 1.73 m 2 . Factors independently associated with no beta‐blocker use were asthma, chronic obstructive pulmonary disease, lower body mass index, dementia, older age, and left ventricular ejection fraction <40%. Patients on beta‐blockers had significantly lower in‐hospital mortality rates (4.4% versus 7.6%, P <0.001). Even after adjusting for confounders, beta‐blocker use at admission remained significantly associated with lower in‐hospital mortality risk (odds ratio, 0.41; 95% CI, 0.27–0.60, P <0.001). Furthermore, beta‐blocker use at admission was significantly associated with both lower cardiovascular mortality risk and lower noncardiovascular mortality risk. The association of beta‐blocker use with lower in‐hospital mortality risk was relatively more prominent in patients receiving high dose beta‐blockers. The magnitude of the effect of beta‐blocker use was greater in patients with previous heart failure hospitalization than in patients without ( P for interaction 0.04). Conclusions Beta‐blocker use at admission was associated with lower in‐hospital mortality in patients with acute decompensated heart failure. Registration URL: https://www.upload.umin.ac.jp/ ; Unique identifier: UMIN000015238.
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Tamaki et al. (2021) conducted a cohort in Acute decompensated heart failure (n=3,817). Beta-blocker use at admission vs. No beta-blocker use at admission was evaluated on In-hospital mortality (OR 0.41, 95% CI 0.27-0.60, p=<0.001). Beta-blocker use at admission in patients with acute decompensated heart failure was associated with lower in-hospital mortality (4.4% vs 7.6%; OR 0.41; 95% CI 0.27-0.60; P<0.001).
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