β-Blockers and 1-year postdischarge mortality for heart failure and reduced ejection fraction and slow discharge heart rate

Jin Joo Park, Hyun Ah Park, Hyun Jai Cho, Hae Young Lee, Kye Hun Kim, Byung Su Yoo, Seok Min Kang, Sang Hong Baek, Eun Seok Jeon, Jae Joong Kim, Myeong Chan Cho, Shung Chull Chae, Byung Hee Oh, Dong Ju Choi

Research output: Contribution to journalArticle

Abstract

Background—Many hospitalized patients with heart failure and reduced ejection fraction (HFrEF) have a slow heart rate at discharge, and the effect of β-blockers may be reduced in those patients. We sought to examine the variable effect of b-blockers on clinical outcomes according to the discharge heart rate of hospitalized HFrEF patients. Methods and Results—The KorAHF (Korean Acute Heart Failure) registry consecutively enrolled 5625 patients hospitalized for acute heart failure. In this analysis, we included patients with HFrEF (left ventricular ejection fraction ≤40%). Slow heart rate was defined as <70 beats per minute regardless of the use of β-blockers. The primary outcome was 1-year all-cause postdischarge death according to heart rate. Among 2932 patients with HFrEF, 840 (29%) had a slow heart rate and 56% received β-blockers at discharge. Patients with slow heart rates were older and had lower 1-year mortality than those with high heart rates (P<0.001). A significant interaction between discharge heart rate and β-blocker use was observed (P<0.001 for interaction). When stratified, only patients without a β-blocker prescription and with a high heart rate showed higher 1-year mortality. In a Cox-proportional hazards regression analysis, β-blocker prescription at discharge was associated with 24% reduced risk for 1-year mortality in patients with high heart rates (hazard ratio: 0.76; 95% CI, 0.61–0.95) but not in those with slow heart rates (hazard ratio: 1.02; 95% CI, 0.68–1.55). Conclusions—Many patients with acute heart failure have slow discharge heart rates, and β-blockers may have a limited effect on HFrEF and slow discharge heart rate.

Original languageEnglish
Article numbere011121
JournalJournal of the American Heart Association
Volume8
Issue number4
DOIs
Publication statusPublished - 2019 Jan 1

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Heart Failure
Heart Rate
Mortality
Prescriptions
Stroke Volume
Registries
Cause of Death
Regression Analysis

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Park, Jin Joo ; Park, Hyun Ah ; Cho, Hyun Jai ; Lee, Hae Young ; Kim, Kye Hun ; Yoo, Byung Su ; Kang, Seok Min ; Baek, Sang Hong ; Jeon, Eun Seok ; Kim, Jae Joong ; Cho, Myeong Chan ; Chae, Shung Chull ; Oh, Byung Hee ; Choi, Dong Ju. / β-Blockers and 1-year postdischarge mortality for heart failure and reduced ejection fraction and slow discharge heart rate. In: Journal of the American Heart Association. 2019 ; Vol. 8, No. 4.
@article{e8d13634a4ad4670bd9b373fe3aff2ca,
title = "β-Blockers and 1-year postdischarge mortality for heart failure and reduced ejection fraction and slow discharge heart rate",
abstract = "Background—Many hospitalized patients with heart failure and reduced ejection fraction (HFrEF) have a slow heart rate at discharge, and the effect of β-blockers may be reduced in those patients. We sought to examine the variable effect of b-blockers on clinical outcomes according to the discharge heart rate of hospitalized HFrEF patients. Methods and Results—The KorAHF (Korean Acute Heart Failure) registry consecutively enrolled 5625 patients hospitalized for acute heart failure. In this analysis, we included patients with HFrEF (left ventricular ejection fraction ≤40{\%}). Slow heart rate was defined as <70 beats per minute regardless of the use of β-blockers. The primary outcome was 1-year all-cause postdischarge death according to heart rate. Among 2932 patients with HFrEF, 840 (29{\%}) had a slow heart rate and 56{\%} received β-blockers at discharge. Patients with slow heart rates were older and had lower 1-year mortality than those with high heart rates (P<0.001). A significant interaction between discharge heart rate and β-blocker use was observed (P<0.001 for interaction). When stratified, only patients without a β-blocker prescription and with a high heart rate showed higher 1-year mortality. In a Cox-proportional hazards regression analysis, β-blocker prescription at discharge was associated with 24{\%} reduced risk for 1-year mortality in patients with high heart rates (hazard ratio: 0.76; 95{\%} CI, 0.61–0.95) but not in those with slow heart rates (hazard ratio: 1.02; 95{\%} CI, 0.68–1.55). Conclusions—Many patients with acute heart failure have slow discharge heart rates, and β-blockers may have a limited effect on HFrEF and slow discharge heart rate.",
author = "Park, {Jin Joo} and Park, {Hyun Ah} and Cho, {Hyun Jai} and Lee, {Hae Young} and Kim, {Kye Hun} and Yoo, {Byung Su} and Kang, {Seok Min} and Baek, {Sang Hong} and Jeon, {Eun Seok} and Kim, {Jae Joong} and Cho, {Myeong Chan} and Chae, {Shung Chull} and Oh, {Byung Hee} and Choi, {Dong Ju}",
year = "2019",
month = "1",
day = "1",
doi = "10.1161/JAHA.118.011121",
language = "English",
volume = "8",
journal = "Journal of the American Heart Association",
issn = "2047-9980",
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Park, JJ, Park, HA, Cho, HJ, Lee, HY, Kim, KH, Yoo, BS, Kang, SM, Baek, SH, Jeon, ES, Kim, JJ, Cho, MC, Chae, SC, Oh, BH & Choi, DJ 2019, 'β-Blockers and 1-year postdischarge mortality for heart failure and reduced ejection fraction and slow discharge heart rate', Journal of the American Heart Association, vol. 8, no. 4, e011121. https://doi.org/10.1161/JAHA.118.011121

β-Blockers and 1-year postdischarge mortality for heart failure and reduced ejection fraction and slow discharge heart rate. / Park, Jin Joo; Park, Hyun Ah; Cho, Hyun Jai; Lee, Hae Young; Kim, Kye Hun; Yoo, Byung Su; Kang, Seok Min; Baek, Sang Hong; Jeon, Eun Seok; Kim, Jae Joong; Cho, Myeong Chan; Chae, Shung Chull; Oh, Byung Hee; Choi, Dong Ju.

In: Journal of the American Heart Association, Vol. 8, No. 4, e011121, 01.01.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - β-Blockers and 1-year postdischarge mortality for heart failure and reduced ejection fraction and slow discharge heart rate

AU - Park, Jin Joo

AU - Park, Hyun Ah

AU - Cho, Hyun Jai

AU - Lee, Hae Young

AU - Kim, Kye Hun

AU - Yoo, Byung Su

AU - Kang, Seok Min

AU - Baek, Sang Hong

AU - Jeon, Eun Seok

AU - Kim, Jae Joong

AU - Cho, Myeong Chan

AU - Chae, Shung Chull

AU - Oh, Byung Hee

AU - Choi, Dong Ju

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background—Many hospitalized patients with heart failure and reduced ejection fraction (HFrEF) have a slow heart rate at discharge, and the effect of β-blockers may be reduced in those patients. We sought to examine the variable effect of b-blockers on clinical outcomes according to the discharge heart rate of hospitalized HFrEF patients. Methods and Results—The KorAHF (Korean Acute Heart Failure) registry consecutively enrolled 5625 patients hospitalized for acute heart failure. In this analysis, we included patients with HFrEF (left ventricular ejection fraction ≤40%). Slow heart rate was defined as <70 beats per minute regardless of the use of β-blockers. The primary outcome was 1-year all-cause postdischarge death according to heart rate. Among 2932 patients with HFrEF, 840 (29%) had a slow heart rate and 56% received β-blockers at discharge. Patients with slow heart rates were older and had lower 1-year mortality than those with high heart rates (P<0.001). A significant interaction between discharge heart rate and β-blocker use was observed (P<0.001 for interaction). When stratified, only patients without a β-blocker prescription and with a high heart rate showed higher 1-year mortality. In a Cox-proportional hazards regression analysis, β-blocker prescription at discharge was associated with 24% reduced risk for 1-year mortality in patients with high heart rates (hazard ratio: 0.76; 95% CI, 0.61–0.95) but not in those with slow heart rates (hazard ratio: 1.02; 95% CI, 0.68–1.55). Conclusions—Many patients with acute heart failure have slow discharge heart rates, and β-blockers may have a limited effect on HFrEF and slow discharge heart rate.

AB - Background—Many hospitalized patients with heart failure and reduced ejection fraction (HFrEF) have a slow heart rate at discharge, and the effect of β-blockers may be reduced in those patients. We sought to examine the variable effect of b-blockers on clinical outcomes according to the discharge heart rate of hospitalized HFrEF patients. Methods and Results—The KorAHF (Korean Acute Heart Failure) registry consecutively enrolled 5625 patients hospitalized for acute heart failure. In this analysis, we included patients with HFrEF (left ventricular ejection fraction ≤40%). Slow heart rate was defined as <70 beats per minute regardless of the use of β-blockers. The primary outcome was 1-year all-cause postdischarge death according to heart rate. Among 2932 patients with HFrEF, 840 (29%) had a slow heart rate and 56% received β-blockers at discharge. Patients with slow heart rates were older and had lower 1-year mortality than those with high heart rates (P<0.001). A significant interaction between discharge heart rate and β-blocker use was observed (P<0.001 for interaction). When stratified, only patients without a β-blocker prescription and with a high heart rate showed higher 1-year mortality. In a Cox-proportional hazards regression analysis, β-blocker prescription at discharge was associated with 24% reduced risk for 1-year mortality in patients with high heart rates (hazard ratio: 0.76; 95% CI, 0.61–0.95) but not in those with slow heart rates (hazard ratio: 1.02; 95% CI, 0.68–1.55). Conclusions—Many patients with acute heart failure have slow discharge heart rates, and β-blockers may have a limited effect on HFrEF and slow discharge heart rate.

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U2 - 10.1161/JAHA.118.011121

DO - 10.1161/JAHA.118.011121

M3 - Article

C2 - 30755071

AN - SCOPUS:85061511922

VL - 8

JO - Journal of the American Heart Association

JF - Journal of the American Heart Association

SN - 2047-9980

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