Key result
Consistent post-cardiac surgery β-blocker use is linked to ~108% higher mortality in severe LV dysfunction.
Why the study?
Few studies have evaluated long-term mortality in patients with low LVEF (≤35%) undergoing a broad range of cardiac procedures.
Does β-blocker therapy improve long-term survival in patients with LVEF ≤35% after cardiac surgery?
Cohort (n=510)
No
Does β-blocker therapy improve long-term survival in patients with LVEF ≤35% after cardiac surgery?
Hazard Ratio: 2.08 (95% CI 1.18–3.66)
Absolute Event Rate: 80.77% vs 61.54%
p-value: p=0.030
In patients with LVEF ≤35% undergoing cardiac surgery, continuous β-blocker therapy was associated with increased long-term mortality, suggesting caution in their routine discharge prescription for this specific population.
Always β-blocker use was associated with higher long-term mortality; leaves open whether discontinuation improves outcomes in prospective trials.
BACKGROUND: Preoperative low left ventricular ejection fraction (LVEF) has been reported as an independent risk factor for in-hospital mortality. However, there were few studies evaluating the long-term mortality in these patients. We, therefore, conducted this study to investigate long-term outcomes of surgery on patients with LVEF≤35% undergoing a broad range of cardiac procedures. METHODS: We performed a retrospective cohort study in 510 patients from January 1, 2007 to September 1, 2019. These patients were divided into survival group (n = 386) and non-survival group (n = 124). The multivariate Cox analysis was used to estimate the risk factors for survival. In Cox analysis, β-blockers were indicated to be associated with long-term mortality. To further address bias, we derived a propensity score predicting the function of β-blockers on survival, and matched 52 cases to 52 controls with similar risk profiles. RESULTS: Patients were followed for a median period of 24 months (interquartile range: 11-44 months). Multivariate Cox regression analysis indicated that the non-survival group had higher weight, higher EuroSCORE, more smoking patients, longer time of cardiopulmonary bypass (CPB), more intra-aortic balloon pump (IABP) use, and more patients who always used β-blocker (HR: 2.056, 95%CI:1.236-3.420, P = 0.005) compared with survival group. After propensity matching, the group which always used β-blocker showed higher rate of all-cause death compare with the control group (61.54% vs 80.77%, P = 0.030). CONCLUSIONS: The risk factors for long-term survival were weight, EuroSCORE, smoking, CPB, IABP, always used β-blockers in patients with LVEF≤35%. The discharge prescription of β-blocker should be cautiously administrated in those patients.
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Fan et al. (2020) conducted a cohort in Low left ventricular ejection fraction (≤35%) after cardiac surgery (n=510). β-blocker therapy vs. Never or inconsistently used β-blockers was evaluated on All-cause death (HR 2.08, 95% CI 1.18-3.66, p=0.030). Consistent use of β-blockers after hospital discharge was associated with a higher rate of all-cause death (HR 2.08) compared to inconsistent or no use in patients with LVEF ≤35% after cardiac surgery.
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