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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 MD  ;  Byung-Hee Oh 
 CANADIAN JOURNAL OF CARDIOLOGY, Vol.34(9) : 1145-1152, 2018 
Journal Title
Issue Date
Adrenergic beta-Antagonists/administration & dosage* ; Aged ; Cardiotonic Agents/therapeutic use ; Disease Progression ; Female ; Follow-Up Studies ; Heart Failure*/diagnosis ; Heart Failure*/drug therapy ; Heart Failure*/mortality ; Heart Failure*/physiopathology ; Humans ; Male ; Middle Aged ; Mortality ; Outcome Assessment (Health Care) ; Patient Discharge/statistics & numerical data* ; Republic of Korea/epidemiology ; Severity of Illness Index ; Stroke Volume/drug effects* ; Ventricular Dysfunction, Left*/diagnosis ; Ventricular Dysfunction, Left*/drug therapy ; Ventricular Dysfunction, Left*/etiology
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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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Seok Min(강석민) ORCID logo https://orcid.org/0000-0001-9856-9227
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