Beta-blockers for post-acute coronary syndrome mid-range ejection fraction: a nationwide retrospective study

Abstract

Background: Patients with mid-range ejection fraction (40–49%) are in focus due to the newly defined entity of heart failure with mid-range ejection fraction. Acute coronary syndromes are a major aetiology for heart failure with mid-range ejection fraction. We aim to evaluate which therapeutic decisions are associated with inhospital survival benefit in post-acute coronary syndrome patients categorised according to the ejection fraction. Methods and results: The authors analysed a cohort of a multicentre national registry enrolling acute coronary syndrome patients between 2010 and 2016, classified according to their ejection fraction before hospital discharge. Patients with previously known heart failure or with no ejection fraction evaluation were excluded. A total of 9429 patients were included and categorised in three groups: (a) ejection fraction of 50% or greater ( n=6113, 65%); (b) ejection fraction of 40–49% ( n=1926, 20%); and (c) ejection fraction less than 40% ( n=1390, 15%). The primary endpoint was inhospital mortality. To eliminate confounding factors, a multivariate logistic regression analysis was conducted, including acute coronary syndrome type, baseline characteristics, pharmacological treatment, clinical data, laboratory data and coronary anatomy when known. The overall inhospital mortality was 2.8% ( n=263): 0.9% ( n=53) in group 1, 2.4% ( n=37) in group 2 and 11.4% ( n=159) in group 3. After multivariate analysis, an invasive strategy had a positive impact in all groups, inhospital beta-blocker administration had a positive impact for groups 2 and 3, and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker and spironolactone had a positive impact on group 3. Conclusion: Post-acute coronary syndrome mid-range ejection fraction patients represent an intermediate risk group in which beta-blocker administration was associated with inhospital survival benefit. An invasive strategy was a survival predictor for all groups, regardless of ejection fraction category.

Heart Failure With Mid-range Ejection Fraction: A Distinctive Subtype or a Transitional Stage?

“…No significant benefit of beta-blockers was observed in patients with HFpEF whether in sinus rhythm or atrial fibrillation ( 69 ). In a nationwide retrospective study, beta-blockers treatment reduced in-hospital mortality in post-acute coronary syndrome patients with HFmrEF ( 70 ). However, a recent observational study indicated that beta-blockers did not improve the long-term prognosis in patients with HFmrEF with IHD.…”

Clinical characteristics and treatment profiles of patients after acute myocardial infarction with left ventricular ejection fraction below 40%: a short 2018–2019 report on the PL‑ACS registry

“…10 According to the PL -ACS registry and the QUALIFY survey, ivabradine was prescribed in 3.5% and 13.9% of patients, respectively, whereas the proportion of patients on this drug was not reported in the Pro -ACS registry. 11,12 Lack of reimbursement for ARNIs in Poland accounts for the prescription rate of these drugs reaching only 1.4% in the PL -ACS registry. Following the European Society of Cardiology guidelines, ARNIs are recommended for pulmonary edema, respectively.…”

“…The use of β -blockers and angiotensin--converting enzyme inhibitors (ACEIs) is recommended in LVSD or HFrEF. 10 The Portuguese Registry of Acute Coronary Syndromes (Pro -ACS) recruited patients with ischemic HFrEF, 11 but excluded those with a history of HFrEF before AMI, while such patients in our study represented 24.9% of the participants. The clinical characteristics of both populations were similar, except diabetes not reported in the Pro--ACS registry.…”

East meets West on acute heart failure

“…From a national registry in Portugal, we learn that patients hospitalized with an acute coronary syndrome and a mid-range ejection fraction (40-49%) represent an intermediate risk group in which beta-blocker treatment results in an in-hospital survival benefit. 6 Another study from the ATTEND registry assessed the impact of admission and discharge anemia status on the outcome of patients admitted with acute decompensated heart failure. 7 The effect of admission and discharge anemia status with outcomes differed between heart failure patients with a preserved or a reduced ejection fraction.…”

“…From a national registry in Portugal, we learn that patients hospitalized with an acute coronary syndrome and a mid-range ejection fraction (40-49%) represent an intermediate risk group in which beta-blocker treatment results in an in-hospital survival benefit. 6…”