Min Soo Cho1, Min-Seok Kim1, Sang Eun Lee1, Hyo-In Choi1, Jung-Bok Lee1, Hyun-Jai Cho2, Hae-Young Lee2, Jin-Oh Choi3, Eun-Seok Jeon3, Kyung-Kuk Hwang4, Shung Chul Chae5, Sang Hong Baek6, Seok-Min Kang7, Dong-Ju Choi8, Byung-Su Yoo9, Youngkeun Ahn10, Kye-Hoon Kim10, Hyun-Young Park11, Myeong-Chan Cho4, Byung-Hee Oh2, Jae-Joong Kim12. 1. University of Ulsan College of Medicine, Seoul, Korea. 2. Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea. 3. Sungkyunkwan University College of Medicine, Seoul, Korea. 4. Chungbuk National University College of Medicine, Cheongju, Korea. 5. Kyungpook National University College of Medicine, Daegu, Korea. 6. The Catholic University of Korea, Seoul, Korea. 7. Yonsei University College of Medicine, Seoul, Korea. 8. Seoul National University Bundang Hospital, Seongnam, Korea. 9. Yonsei University Wonju College of Medicine, Wonju, Korea. 10. Heart Research Center of Chonnam National University, Gwangju, Korea. 11. National Institute of Health, Osong, Korea. 12. University of Ulsan College of Medicine, Seoul, Korea. Electronic address: jjkim@amc.seoul.kr.
Abstract
BACKGROUND: The optimal time for initiating β-blocker (BB) treatment in patients with severe acute decompensated heart failure requiring inotropic therapy has not been well defined. We evaluated the effect of predischarge initiation of BB treatment on clinical outcomes. METHODS: Among the 5625 patients enrolled in the Korean Acute Heart Failure (KorAHF) registry, 672 BB-naive patients suffering from heart failure with reduced ejection fraction (median, 67.0 years; 62.5% male; median left ventricular ejection fraction, 24.1%) who received inotropic support during hospitalization were evaluated. We compared the risk of post-discharge mortality and rehospitalization between groups with (n = 282) and without (n = 390) pre-discharge BB treatment. RESULTS: During a median follow-up of 2.6 years, all-cause mortality occurred in 252 patients (37.5%). Those who received pre-discharge BB treatment showed lower 2-year mortality rates compared with those who did not (21.3% vs 39.3%; P < 0.001). In a Cox proportional hazards model, all-cause mortality was consistently lower in pre-discharge BB groups after multivariable adjustment (hazard ratio, 0.69; 95% confidence interval, 0.50-0.95; P = 0.025) and adjustment for propensity score methods using the inverse probability of treatment weighting (hazard ratio, 0.70; 95% confidence interval, 0.52-0.93; P = 0.016). The same trend was observed for secondary outcomes of rehospitalization for any cause and rehospitalization for heart failure. Pre-discharge BB was associated with higher rates of BB prescription after 6 (90.1% vs 23.9%; P < 0.001) and 12 (88.9% vs 25.0%; P < 0.001) months. CONCLUSIONS: Pre-discharge BB initiation is associated with better clinical outcomes after severe acute decompensated heart failure episodes requiring inotropic therapy.
BACKGROUND: The optimal time for initiating β-blocker (BB) treatment in patients with severe acute decompensated heart failure requiring inotropic therapy has not been well defined. We evaluated the effect of predischarge initiation of BB treatment on clinical outcomes. METHODS: Among the 5625 patients enrolled in the Korean Acute Heart Failure (KorAHF) registry, 672 BB-naive patients suffering from heart failure with reduced ejection fraction (median, 67.0 years; 62.5% male; median left ventricular ejection fraction, 24.1%) who received inotropic support during hospitalization were evaluated. We compared the risk of post-discharge mortality and rehospitalization between groups with (n = 282) and without (n = 390) pre-discharge BB treatment. RESULTS: During a median follow-up of 2.6 years, all-cause mortality occurred in 252 patients (37.5%). Those who received pre-discharge BB treatment showed lower 2-year mortality rates compared with those who did not (21.3% vs 39.3%; P < 0.001). In a Cox proportional hazards model, all-cause mortality was consistently lower in pre-discharge BB groups after multivariable adjustment (hazard ratio, 0.69; 95% confidence interval, 0.50-0.95; P = 0.025) and adjustment for propensity score methods using the inverse probability of treatment weighting (hazard ratio, 0.70; 95% confidence interval, 0.52-0.93; P = 0.016). The same trend was observed for secondary outcomes of rehospitalization for any cause and rehospitalization for heart failure. Pre-discharge BB was associated with higher rates of BB prescription after 6 (90.1% vs 23.9%; P < 0.001) and 12 (88.9% vs 25.0%; P < 0.001) months. CONCLUSIONS: Pre-discharge BB initiation is associated with better clinical outcomes after severe acute decompensated heart failure episodes requiring inotropic therapy.