Beta-Blocker Use and Outcomes Among Hospitalized Heart Failure Patients

Butler, Javed; Young, James B.; Abraham, William T.; Bourge, Robert C.; Adams, Kirkwood F.; Clare, Robert; O’Connor, Christopher M.

doi:10.1016/j.jacc.2006.03.030

Cited by 91 publications

(58 citation statements)

References 13 publications

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“…Future studies are need to investigate whether cardiac resynchronization therapy during hospitalization and the prescription of beta-blockers at the time of hospital discharge might favorably reduce post-discharge mortality compared to patients without HF hospitalizations. [36][37][38] A recent post hoc analysis of CHARM database demonstrated that post-baseline "discharge for first hospitalization for HF" was independently associated with increased mortality (HR 3.15; 95% CI, 2.83-3.50; p<0.0001). 39 This is very similar to the association observed in the current study (HR, 2.49, 95%CI, 1.97-3.13; p<0.0001) and provide cumulative evidence of the deleterious effect of HF hospitalization on subsequent survival in chronic HF.…”

Section: Discussionmentioning

confidence: 99%

Incident Heart Failure Hospitalization and Subsequent Mortality in Chronic Heart Failure: A Propensity-Matched Study

Ahmed

Allman

Fonarow³

et al. 2008

Journal of Cardiac Failure

142

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Section: Discussionmentioning

confidence: 99%

Incident Heart Failure Hospitalization and Subsequent Mortality in Chronic Heart Failure: A Propensity-Matched Study

Ahmed

Allman

Fonarow³

et al. 2008

Journal of Cardiac Failure

142

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“…17 Other studies have also reported pretreatment BP as a predictor of h-blocker tolerability in patients with HF. 7,[18][19][20] Although the tolerability of nebivolol (as with many drug treatments) may be dependent on a more favorable clinical profile, it is also possible that physicians were more likely to withhold the treatment if side effects occurred in bsickerQ patients. Our data show that given the markedly increased risk on all outcomes in these patients, increased efforts should be made to initiate and maintain h-blocker therapy wherever possible in elderly patients with HF.…”

Section: Discussionmentioning

confidence: 99%

Tolerability and dose-related effects of nebivolol in elderly patients with heart failure: Data from the Study of the Effects of Nebivolol Intervention on Outcomes and Rehospitalisation in Seniors with Heart Failure (SENIORS) trial

Dobre¹,

Veldhuisen²,

Mordenti³

et al. 2007

American Heart Journal

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“…Continuation of β‐blocker therapy at the time of hospital discharge has been shown to reduce both readmission and mortality rates after ADHF admissions 10, 11, 12. The impact of continuing or discontinuing ACEi/ARB after ADHF hospitalization has not been as well studied.…”

Section: Introductionmentioning

confidence: 99%

Initiation, Continuation, or Withdrawal of Angiotensin‐Converting Enzyme Inhibitors/Angiotensin Receptor Blockers and Outcomes in Patients Hospitalized With Heart Failure With Reduced Ejection Fraction

Gilstrap

Fonarow

Desai

et al. 2017

JAHA

122

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BackgroundGuidelines recommend continuation or initiation of guideline‐directed medical therapy, including angiotensin‐converting enzyme inhibitors/angiotensin II receptor blockers (ACEi/ARB), in hospitalized patients with heart failure with reduced ejection fraction.Methods and ResultsUsing the Get With The Guidelines‐Heart Failure Registry, we linked clinical data from 16 052 heart failure with reduced ejection fraction (ejection fraction ≤40%) patients with Medicare claims data. We divided ACEi/ARB‐eligible patients into 4 categories based on admission and discharge ACEi/ARB use: continued (reference group), started, discontinued, or not started on therapy. A multivariable Cox proportional hazard model was used to determine the association between ACEi/ARB category and outcomes. Most, 90.5%, were discharged on ACEi/ARB (59.6% continued and 30.9% newly started). Of those discharged without ACEi/ARB, 1.9% were discontinued, and 7.5% were eligible but not started. Thirty‐day mortality was 3.5% for patients continued and 4.1% for patients started on ACEi/ARB. In contrast, 30‐day mortality was 8.8% for patients discontinued (adjusted hazard ratio [HR adj] 1.92; 95% CI 1.32‐2.81; P<0.001) and 7.5% for patients not started (HR adj 1.50; 95% CI 1.12‐2.00; P=0.006). The 30‐day readmission rate was lowest among patients continued or started on therapy. One‐year mortality was 28.2% for patients continued and 29.7% for patients started on ACEi/ARB compared to 41.6% for patients discontinued (HR adj 1.35; 95% CI 1.13‐1.61; P<0.001) and 41.7% (HR adj 1.28; 95% CI 1.14‐1.43; P<0.001) for patients not started on therapy.ConclusionsCompared with continuation, withdrawal of ACEi/ARB during heart failure hospitalization is associated with higher rates of postdischarge mortality and readmission, even after adjustment for severity of illness.

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Beta-Blocker Use and Outcomes Among Hospitalized Heart Failure Patients

Abstract: Beta-blocker therapy before and during hospitalization for HF is associated with improved outcomes.

Cited by 91 publications

References 13 publications

Incident Heart Failure Hospitalization and Subsequent Mortality in Chronic Heart Failure: A Propensity-Matched Study

Incident Heart Failure Hospitalization and Subsequent Mortality in Chronic Heart Failure: A Propensity-Matched Study

Tolerability and dose-related effects of nebivolol in elderly patients with heart failure: Data from the Study of the Effects of Nebivolol Intervention on Outcomes and Rehospitalisation in Seniors with Heart Failure (SENIORS) trial

Initiation, Continuation, or Withdrawal of Angiotensin‐Converting Enzyme Inhibitors/Angiotensin Receptor Blockers and Outcomes in Patients Hospitalized With Heart Failure With Reduced Ejection Fraction

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