Beta-blocker use at hospital admission beneficial in acute decompensated HF
Beta-blocker use at hospital admission for acute decompensated HF was associated with lower in-hospital mortality compared with nonuse before hospitalization, researchers reported.
This effect was strongest among patients taking higher-dose beta-blockers at admission and those with a prior HF hospitalization, according to the researchers.
“In the present study, we demonstrated the significantly lower in-hospital mortality risk of patients receiving beta-blockers at admission relative to those not receiving beta-blockers at admission, regardless of ischemic etiology and [left ventricular ejection fraction], using the current extensive database of acute decompensated HF,” Yodo Tamaki, MD, of the department of cardiovascular medicine at the graduate school of medicine at Kyoto University, and colleagues wrote.
Using data from the Kyoto Congestive Heart Failure registry, researchers identified characteristics associated with beta-blocker use at hospital admission for acute decompensated HF and the effect of beta-blockers on in-hospital mortality. Of the 3,817 patients in the overall cohort, 39.7% received beta-blockers at hospital admission and 60.3% did not.
Researchers found that factors associated with beta-blocker use at admission for acute decompensated HF included:
- previous HF hospitalization;
- prior MI;
- atrial fibrillation;
- cardiomyopathy; and
- estimated glomerular filtration rate less than 30 mL/min/1.73 m2 (P < .001 for all).
Among patients not taking beta-blockers at hospital admission, the most common factors included:
- asthma (P = .002);
- chronic obstructive pulmonary disease (P = .08);
- lower BMI (P < .001);
- dementia (P < .001);
- older age (P = .003); and
- LVEF less than 40% (P = .03).
Researchers reported that beta-blocker use at hospital admission for acute decompensated HF was associated with less in-hospital mortality (4.4% vs. 7.6%; P < .001), a finding that remained significant after adjusting for confounders (adjusted OR = 0.41; 95% CI, 0.27-0.6; P < .001).
Moreover, beta-blocker use was associated with lower risk for all-cause death (aOR = 0.42; 95% CI, 0.28-0.61; P < .001) and CV mortality (aOR = 0.41; 95% CI, 0.26-0.65; P < .001).
Risk for in-hospital mortality was even lower among patients taking higher-dose beta-blockers compared with none at hospital admission (aOR for high dose vs. none = 0.35; 95% CI, 0.19-0.61; aOR for low dose vs. none = 0.43; 95% CI, 0.27-0.68; P for trend < .001), and the benefits of beta-blocker use was greatest among patients with previous HF hospitalization (aOR for prior hospitalization = 0.32; 95% CI, 0.18-0.54; aOR for no prior hospitalization = 0.62; 95% CI, 0.34-1.08; P for interaction = .04).
“Up to 50% of the patients who were not receiving beta-blockers at admission did receive beta-blockers by the time of discharge. Starting beta-blockers during hospitalization in patients not receiving beta-blockers at admission would diminish the effect of beta-blockers,” the researchers wrote. “Nonetheless, beta-blocker use at admission was significantly associated with lower in-hospital mortality. This might suggest beta-blocker use at very early phase of acute decompensation is crucial.”