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AimsPrevious large-scale, retrospective studies have shown increased mortality in heart failure (HF) patients using b2-agonists (B2As). We further examined the relationship between B2A use and mortality in a well-characterized population by adjusting for natriuretic peptide levels as a measure of HF severity. Methods and resultsThis was a retrospective cohort study of patients attending an HF Disease Management Programme with mean follow-up of 2.9 + 2.4 years. Chart review confirmed B2A use, dose and duration of use, and documented pulmonary function evaluation. The primary endpoint was the effect of B2A use compared with no B2A use on mortality using unadjusted and adjusted Kaplan2Meier survival curves. Data were available for 1294 patients (age 70.6 + 11.5 years) of whom 64% were male and 22.2% were taking B2As. b2-Agonist users were older, more likely to be male, to have smoked, to have chronic obstructive pulmonary disease (COPD) and asthma, and less likely to take beta-blockers. Multivariable associates of mortality included: B-type natriuretic peptide (BNP), coronary artery disease, age, and beta-blocker use. Unadjusted mortality rates for B2A users were found to be significantly higher than non-B2A users [hazard ratio (HR) 1.304, 95% confidence interval (CI) 1.030-1.652, P ¼ 0.028]. However, when adjusted for age, sex, medication, co-morbidity, smoking, COPD, and BNP differences, overall mortality rates were similar [HR 1.043, 95% CI (0.771 -1.412), P ¼ 0.783]. ConclusionUnlike previous reports, this retrospective evaluation of B2A therapy in HF patients shows no relationship with longterm mortality when adjusted for population differences including BNP. Large, prospective studies are required to define the risk/benefit ratio of B2As in patients with heart failure.--

Background Despite the known benefits of ambulation, most hospitalized patients remain physically inactive. One possible approach to this problem is to employ Ambulation Orderlies (AOs) – employees whose main responsibility is to ambulate patients throughout the day. For this study, we examined an AO program implemented among post-cardiac surgery patients and its effect on patient outcomes. Methods We evaluated post-operative length of stay, hospital complications, discharge disposition, and 30-day readmission for all patients who underwent coronary artery bypass and/or cardiac valve surgery in the nine months before and after the introduction of the AO program. In addition to pre-post comparisons, we performed an interrupted time series analysis to adjust for temporal trends and differences in baseline characteristics. Results We included 447 and 478 patients in the pre- and post-AO intervention groups, respectively. Post-operative length of stay was lower in the post-AO group, with median (IQR) of 10 (7,14) days versus 9 (7,13) days (p<0.001), and also had significantly less variability in mean monthly length of stay (Levene’s test p=0.03). Using adjusted interrupted time series analysis, the program was associated with a decreased mean monthly post-operative length of stay (-1.57 days, p=0.04), as well as a significant decrease in the trend of mean monthly post-operative length of stay (p=0.01). Other outcomes were unaffected. Conclusion The implementation of an AO program was associated with a significant reduction in post-operative length and variability of hospital stay. These results suggest that an AO program is a reasonable and practical approach towards improving hospital outcomes.