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

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Heart Failure
Mortality
Therapeutics
Confidence Intervals
Propensity Score
Proportional Hazards Models
Stroke Volume
Prescriptions
Registries
Hospitalization

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Cho, Min Soo ; Kim, Min Seok ; Lee, Sang Eun ; Choi, Hyo In ; Lee, Jung Bok ; Cho, Hyun Jai ; Lee, Hae Young ; Choi, Jin Oh ; Jeon, Eun Seok ; Hwang, Kyung Kuk ; Chae, Shung Chul ; Baek, Sang Hong ; Kang, Seok Min ; Choi, Dong Ju ; Yoo, Byung Su ; Ahn, Youngkeun ; Kim, Kye Hoon ; Park, Hyun Young ; Cho, Myeong Chan ; Oh, Byung Hee ; Kim, Jae Joong. / Outcomes After Predischarge Initiation of β-Blocker in Patients Hospitalized for Severe Decompensated Heart Failure Requiring Inotropic Therapy. In: Canadian Journal of Cardiology. 2018 ; Vol. 34, No. 9. pp. 1145-1152.
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title = "Outcomes After Predischarge Initiation of β-Blocker in Patients Hospitalized for Severe Decompensated Heart Failure Requiring Inotropic Therapy",
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.",
author = "Cho, {Min Soo} and Kim, {Min Seok} and Lee, {Sang Eun} and Choi, {Hyo In} and Lee, {Jung Bok} and Cho, {Hyun Jai} and Lee, {Hae Young} and Choi, {Jin Oh} and Jeon, {Eun Seok} and Hwang, {Kyung Kuk} and Chae, {Shung Chul} and Baek, {Sang Hong} and Kang, {Seok Min} and Choi, {Dong Ju} and Yoo, {Byung Su} and Youngkeun Ahn and Kim, {Kye Hoon} and Park, {Hyun Young} and Cho, {Myeong Chan} and Oh, {Byung Hee} and Kim, {Jae Joong}",
year = "2018",
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issn = "0828-282X",
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Cho, MS, Kim, MS, Lee, SE, Choi, HI, Lee, JB, Cho, HJ, Lee, HY, Choi, JO, Jeon, ES, Hwang, KK, Chae, SC, Baek, SH, Kang, SM, Choi, DJ, Yoo, BS, Ahn, Y, Kim, KH, Park, HY, Cho, MC, Oh, BH & Kim, JJ 2018, 'Outcomes After Predischarge Initiation of β-Blocker in Patients Hospitalized for Severe Decompensated Heart Failure Requiring Inotropic Therapy', Canadian Journal of Cardiology, vol. 34, no. 9, pp. 1145-1152. https://doi.org/10.1016/j.cjca.2018.05.005

Outcomes After Predischarge Initiation of β-Blocker in Patients Hospitalized for Severe Decompensated Heart Failure Requiring Inotropic Therapy. / Cho, Min Soo; Kim, Min Seok; Lee, Sang Eun; Choi, Hyo In; Lee, Jung Bok; Cho, Hyun Jai; Lee, Hae Young; Choi, Jin Oh; Jeon, Eun Seok; Hwang, Kyung Kuk; Chae, Shung Chul; Baek, Sang Hong; Kang, Seok Min; Choi, Dong Ju; Yoo, Byung Su; Ahn, Youngkeun; Kim, Kye Hoon; Park, Hyun Young; Cho, Myeong Chan; Oh, Byung Hee; Kim, Jae Joong.

In: Canadian Journal of Cardiology, Vol. 34, No. 9, 09.2018, p. 1145-1152.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Outcomes After Predischarge Initiation of β-Blocker in Patients Hospitalized for Severe Decompensated Heart Failure Requiring Inotropic Therapy

AU - Cho, Min Soo

AU - Kim, Min Seok

AU - Lee, Sang Eun

AU - Choi, Hyo In

AU - Lee, Jung Bok

AU - Cho, Hyun Jai

AU - Lee, Hae Young

AU - Choi, Jin Oh

AU - Jeon, Eun Seok

AU - Hwang, Kyung Kuk

AU - Chae, Shung Chul

AU - Baek, Sang Hong

AU - Kang, Seok Min

AU - Choi, Dong Ju

AU - Yoo, Byung Su

AU - Ahn, Youngkeun

AU - Kim, Kye Hoon

AU - Park, Hyun Young

AU - Cho, Myeong Chan

AU - Oh, Byung Hee

AU - Kim, Jae Joong

PY - 2018/9

Y1 - 2018/9

N2 - 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.

AB - 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.

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