Beta-blocker discontinuation during ADHF hospitalization showed an uncertain association with in-hospital mortality compared to continuation (pooled OR 5.20; 95% CI 0.24-113.06).
Meta-Analysis (n=14,801)
Does beta-blocker discontinuation affect in-hospital mortality in patients hospitalized for acute decompensated heart failure?
Current evidence regarding beta-blocker discontinuation during acute decompensated heart failure is of very low certainty, with highly uncertain effects on in-hospital mortality.
Odds Ratio: 5.2 (95% CI 0.24–113.06)
BACKGROUND: Whether beta-blockers should be continued during hospitalization for acute decompensated heart failure (ADHF) remains uncertain. OBJECTIVES: The objective of the study was to conduct a systematic review on continuation vs discontinuation of beta-blockers during ADHF hospitalization (PROSPERO CRD42024557727). METHODS: We searched MEDLINE, Embase, and CENTRAL from inception to September 11, 2025. We included randomized and observational studies comparing beta-blocker discontinuation with continuation during hospitalization for ADHF and grouped studies by timing of discontinuation. We conducted meta-analysis of observational studies using generic inverse-variance random-effects models, prioritizing adjusted estimates. RESULTS: Thirteen studies met the eligibility criteria: 1 randomized trial (n = 147) and 12 cohort studies (n = 14,654). The associated risk of in-hospital mortality was uncertain for beta-blocker discontinuation vs continuation (pooled OR: 5.20; 95% CI: 0.24-113.06; I CONCLUSIONS: Available evidence on beta-blocker discontinuation in ADHF is of very low certainty and findings of possible harm may reflect confounding by indication and failure to restart therapy rather than causal harm. Further high-quality randomized controlled trials and nonrandomized studies may resolve uncertainty.
Alaeiilkhchi et al. (Thu,) führten eine Meta-Analyse zur akuten dekompensierten Herzinsuffizienz (ADHF) (n=14.801) durch. Das Absetzen von Beta-Blockern im Vergleich zur Fortsetzung wurde hinsichtlich der Sterblichkeit im Krankenhaus bewertet (OR 5,20, 95% CI 0,24-113,06). Das Absetzen der Beta-Blocker während des Krankenhausaufenthalts bei ADHF zeigte eine unsichere Assoziation mit der Sterblichkeit im Krankenhaus im Vergleich zur Fortsetzung (kombiniertes OR 5,20; 95% CI 0,24-113,06).
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