Outcomes After Predischarge Initiation of β-Blocker in Patients Hospitalized for Severe Decompensated Heart Failure Requiring Inotropic Therapy

Min Soo Cho, Min Seok Kim, Sang Eun Lee, Hyo In Choi, Jung Bok Lee, Hyun Jai Cho, Hae Young Lee, Jin Oh Choi, Eun Seok Jeon, Kyung Kuk Hwang, Shung Chul Chae, Sang Hong Baek, Seok Min Kang, Dong Ju Choi, Byung Su Yoo, Youngkeun Ahn, Kye Hoon Kim, Hyun Young Park, Myeong Chan Cho, Byung Hee OhJae Joong Kim

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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.

Original languageEnglish
Pages (from-to)1145-1152
Number of pages8
JournalCanadian Journal of Cardiology
Volume34
Issue number9
DOIs
Publication statusPublished - 2018 Sep

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

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    Cho, M. S., Kim, M. S., Lee, S. E., Choi, H. I., Lee, J. B., Cho, H. J., Lee, H. Y., Choi, J. O., Jeon, E. S., Hwang, K. K., Chae, S. C., Baek, S. H., Kang, S. M., Choi, D. J., Yoo, B. S., Ahn, Y., Kim, K. H., Park, H. Y., Cho, M. C., ... Kim, J. J. (2018). Outcomes After Predischarge Initiation of β-Blocker in Patients Hospitalized for Severe Decompensated Heart Failure Requiring Inotropic Therapy. Canadian Journal of Cardiology, 34(9), 1145-1152. https://doi.org/10.1016/j.cjca.2018.05.005