Kurt W Prins1, John M Neill2, John O Tyler2, Peter M Eckman3, Sue Duval3. 1. Cardiovascular Division, University of Minnesota Medical School, Minneapolis, Minnesota. Electronic address: prin0088@umn.edu. 2. Department of Internal Medicine, University of Alabama-Birmingham, Birmingham, Alabama. 3. Cardiovascular Division, University of Minnesota Medical School, Minneapolis, Minnesota.
Abstract
OBJECTIVES: This study sought to evaluate the effects of beta-blocker withdrawal in acute decompensated heart failure (ADHF). BACKGROUND: Published reports showed trends for either no harm or increased risk of in-hospital mortality, short-term mortality, and rehospitalization rates in patients admitted for ADHF that discontinued beta-blockers; however, a comprehensive analysis has not been conducted. METHODS: Relevant studies from January 2000 through January 2015 were identified in the PubMed, EMBASE, and COCHRANE electronic databases. Where appropriate data were available, weighted relative risks were estimated using random-effects meta-analysis techniques. RESULTS: Five observational studies and 1 randomized clinical trial (n = 2,704 patients who continued beta-blocker therapy and n = 439 patients who discontinued beta-blocker therapy) that reported the short-term effects of beta-blocker withdrawal in ADHF were included in the analyses. In 2 studies, beta-blocker withdrawal significantly increased risk of in-hospital mortality (risk ratio: 3.72; 95% confidence interval [CI]: 1.51 to 9.14). Short-term mortality (relative risk: 1.61; 95% CI: 1.04 to 2.49; 4 studies) and combined short-term rehospitalization or death (relative risk: 1.59; 95% CI: 1.03 to 2.45; 4 studies) were also significantly increased. CONCLUSIONS: Discontinuation of beta-blockers in patients admitted with ADHF was associated with significantly increased in-hospital mortality, short-term mortality, and the combined endpoint of short-term rehospitalization or mortality. These data suggest beta-blockers should be continued in ADHF patients if their clinical picture allows.
OBJECTIVES: This study sought to evaluate the effects of beta-blocker withdrawal in acute decompensated heart failure (ADHF). BACKGROUND: Published reports showed trends for either no harm or increased risk of in-hospital mortality, short-term mortality, and rehospitalization rates in patients admitted for ADHF that discontinued beta-blockers; however, a comprehensive analysis has not been conducted. METHODS: Relevant studies from January 2000 through January 2015 were identified in the PubMed, EMBASE, and COCHRANE electronic databases. Where appropriate data were available, weighted relative risks were estimated using random-effects meta-analysis techniques. RESULTS: Five observational studies and 1 randomized clinical trial (n = 2,704 patients who continued beta-blocker therapy and n = 439 patients who discontinued beta-blocker therapy) that reported the short-term effects of beta-blocker withdrawal in ADHF were included in the analyses. In 2 studies, beta-blocker withdrawal significantly increased risk of in-hospital mortality (risk ratio: 3.72; 95% confidence interval [CI]: 1.51 to 9.14). Short-term mortality (relative risk: 1.61; 95% CI: 1.04 to 2.49; 4 studies) and combined short-term rehospitalization or death (relative risk: 1.59; 95% CI: 1.03 to 2.45; 4 studies) were also significantly increased. CONCLUSIONS: Discontinuation of beta-blockers in patients admitted with ADHF was associated with significantly increased in-hospital mortality, short-term mortality, and the combined endpoint of short-term rehospitalization or mortality. These data suggest beta-blockers should be continued in ADHFpatients if their clinical picture allows.
Authors: Faiez Zannad; John J V McMurray; Henry Krum; Dirk J van Veldhuisen; Karl Swedberg; Harry Shi; John Vincent; Stuart J Pocock; Bertram Pitt Journal: N Engl J Med Date: 2010-11-14 Impact factor: 91.245
Authors: Michael Böhm; Andreas Link; Danlin Cai; Markku S Nieminen; Gerasimos S Filippatos; Reda Salem; Alain Cohen Solal; Bidan Huang; Robert J Padley; Matti Kivikko; Alexandre Mebazaa Journal: Crit Care Med Date: 2011-05 Impact factor: 7.598
Authors: Alan S Go; Dariush Mozaffarian; Véronique L Roger; Emelia J Benjamin; Jarett D Berry; Michael J Blaha; Shifan Dai; Earl S Ford; Caroline S Fox; Sheila Franco; Heather J Fullerton; Cathleen Gillespie; Susan M Hailpern; John A Heit; Virginia J Howard; Mark D Huffman; Suzanne E Judd; Brett M Kissela; Steven J Kittner; Daniel T Lackland; Judith H Lichtman; Lynda D Lisabeth; Rachel H Mackey; David J Magid; Gregory M Marcus; Ariane Marelli; David B Matchar; Darren K McGuire; Emile R Mohler; Claudia S Moy; Michael E Mussolino; Robert W Neumar; Graham Nichol; Dilip K Pandey; Nina P Paynter; Matthew J Reeves; Paul D Sorlie; Joel Stein; Amytis Towfighi; Tanya N Turan; Salim S Virani; Nathan D Wong; Daniel Woo; Melanie B Turner Journal: Circulation Date: 2013-12-18 Impact factor: 29.690
Authors: Samuel M Galvagno; Stephen Thomas; Christopher Stephens; Elliott R Haut; Jon M Hirshon; Douglas Floccare; Peter Pronovost Journal: Cochrane Database Syst Rev Date: 2013-03-28
Authors: Elena-Laura Antohi; Andrew P Ambrosy; Sean P Collins; Ali Ahmed; Vlad Anton Iliescu; Gad Cotter; Peter S Pang; Javed Butler; Ovidiu Chioncel Journal: Am J Ther Date: 2019 Mar/Apr Impact factor: 2.688
Authors: Richard H Tran; Ahmed Aldemerdash; Patricia Chang; Carla A Sueta; Brystana Kaufman; Josephine Asafu-Adjei; Orly Vardeny; Eliza Daubert; Khalid A Alburikan; Anna M Kucharska-Newton; Sally C Stearns; Jo E Rodgers Journal: Pharmacotherapy Date: 2018-03-22 Impact factor: 4.705
Authors: Raban V Jeger; Otmar Pfister; Dragana Radovanovic; Franz R Eberli; Hans Rickli; Philip Urban; Giovanni Pedrazzini; Jean-Christophe Stauffer; Jörg Nossen; Paul Erne Journal: Clin Cardiol Date: 2017-06-09 Impact factor: 2.882
Authors: Feby Savira; Ruth Magaye; Danny Liew; Christopher Reid; Darren J Kelly; Andrew R Kompa; S Jeson Sangaralingham; John C Burnett; David Kaye; Bing H Wang Journal: Br J Pharmacol Date: 2020-05-13 Impact factor: 8.739
Authors: Òscar Miró; Christian Müller; Francisco Javier Martín-Sánchez; Héctor Bueno; Alexander Mebazaa; Pablo Herrero; Javier Jacob; Víctor Gil; Rosa Escoda; Pere Llorens Journal: Clin Res Cardiol Date: 2016-07-05 Impact factor: 5.460