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Beta-blocker Therapy at Discharge in Patients with Acute Heart Failure and Atrial Fibrillation

Authors
 Min Soo Ahn  ;  Byung Su Yoo  ;  Jung Woo Son  ;  Min Heui Yu  ;  Dae Ryong Kang  ;  Hae Young Lee  ;  Eun Seok Jeon  ;  Jae Joong Kim  ;  Shung Chull Chae  ;  Sang Hong Baek  ;  Seok Min Kang  ;  Dong Ju Choi  ;  Kye Hun Kim  ;  Myeong Chan Cho  ;  Seong Yoon Kim 
Citation
 JOURNAL OF KOREAN MEDICAL SCIENCE, Vol.35(33) : e278, 2020-08 
Journal Title
 JOURNAL OF KOREAN MEDICAL SCIENCE 
ISSN
 1011-8934 
Issue Date
2020-08
Keywords
Atrial Fibrillation ; Heart Failure ; β-blocker
Abstract
Background: β-blockers (BBs) are considered primary therapy in stable heart failure (HF) with reduced ejection fraction (HFrEF) without atrial fibrillation (AF); evidence-based benefits of BB on outcome have been documented. However, BBs have not been shown to improve mortality or reduce hospital admissions in HF patients with AF. This study assessed the relationship between BBs at discharge and relevant clinical outcomes in acute heart failure (AHF) patients with AF. Methods: From the Korean Acute Heart Failure Registry, 936 HFrEF and 639 HF patients with preserved ejection fraction (HFpEF) and AF were selected. Propensity score (PS) matching accounted for BB selection bias when assessing associations. Results: BB-untreated patients in the overall cohort of HFrEF and HFpEF had greater deteriorated clinical and laboratory characteristics. In the 670 PS-matched cohort of HFrEF patients, incidences of all clinical events at 60 days and 1 year were not different according to use of BBs. In the 470 PS-matched cohort of HFpEF, rehospitalization and composite outcome at 6 months and 1 year more frequently occurred in non-users of BBs. After adjusting for covariates in the multivariable Cox model of matched cohorts, BB was not associated with clinical outcomes at 60 days and 1 year in HFrEF with AF patients. In HFpEF patients with AF, BB use was associated with reduced 6-month (hazard ratio [HR], 0.38; 95% confidence interval [CI], 0.20-0.74) and 1-year rehospitalization (HR, 0.53; 95% CI, 0.34-0.82). Conclusion: In the HFrEF with AF PS-matched cohort, the use of BBs at discharge was not associated with clinical outcome. However, in HFpEF with AF, the use of BB was associated with reduced rehospitalization during the 6-month and 1-year follow up.
Files in This Item:
T202004784.pdf Download
DOI
10.3346/jkms.2020.35.e278
Appears in Collections:
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
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/180458
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