Should beta-Blockers Be Continued for Patients Hospitalized with decompenstated Heart Failure

October,3 2008 By Michael W Tempelhof, MD [mailto:tempe004@mc.duke.edu]

The continuation of beta-blockers on hospitalization for decompensated, systolic heart failure was associated with improved clinical outcomes and that discontinuation of beta-blocker therapy conferred negative clinical outcomes.

Decompensated heart failure is among the top five reasons for hospitalization in the United States. With an associated mortality rate of 30%, national guidelines have been established in an effort to optimize care for the heart failure patient. Despite the paucity of evidence analyzing whether beta-blocker therapy should be continued or withdrawn during hospitalization for patients with decompensated heart failure; ACC/AHA guidelines recommend the utilization of beta-blockers in all hospitalized, symptomatic patients with decompensated systolic heart failure.

Few, retrospective analyses have assessed outcomes for hospitalized, heart failure patients in which beta-blocker therapy was either continued or withdrawn on admission. This trial, examining data from OPTIMIZE-HF (Organized Program to Initiate Life saving Treatment in Hospitalized Patients with HeartFailure), prospectively assessed outcomes data from a broad cohort of heart failure patients.

2720 patients with a documented LVEF <40% or labeled as moderate to severe systolic dysfunction by qualitative assessment were included in the study. Using a risk and propensity-adjusted analyses, the authors discovered that the 1350 patients who where maintained on beta-blocker therapy at admission had reduced risks of all-cause mortality (hazard ratio (95% CI) at 60-90 days following discharge of 0.60 (0.37-0.99) (p=0.044) and a composite risk of mortality or rehospitalization within 60 to 90 days of discharge (hazard ratio (95% CI) of 0.69 (0.52-0.92) (p=0.012). Withdrawing beta-blocker therapy upon admission resulted in an increased mortality risk (hazard ratio (95% CI) of 2.34 (1.20-4.55) (p=0.006), and an increased composite mortality or re-hospitalization risk (hazard ratio (95% CI) within 60-90 days of discharge of 1.11 (0.67-1.85) (p=0.002). Initiating patients on beta-blockers at presentation was associated with reductions all-cause mortality (hazard ratio (95% CI) at 60-90 days following discharge of 0.41 (0.22-0.78) (p=0.013) and a composite mortality or re-hospitalization risk (hazard ratio (95% CI) within 60-90 days of discharge of 0.61 (0.44-0.83) (p=0.013).

The investigators concluded that the continuation of beta-blocker therapy for hospitalized patients with decompensated systolic heart failure is associated with favorable mortality and rehospitalization risks up to 90 days following discharge. Withdrawal of beta-blockers in this patient population resulted in a substantial increase in mortality and rehospitalization risk.

Source
http://content.onlinejacc.org/cgi/content/abstract/52/3/190