Abstract
Objectives Beta blockers reduce mortality in heart failure (HF). However, it is not clear whether they should be temporarily withdrawn during acute HF. Design Analysis of prospectively collected data. Setting The Gulf aCute heArt failuRe rEgistry is a prospective multicentre study of patients hospitalised with acute HF in seven Middle Eastern countries. Participants 5005 patients with acute HF. Outcome measures We studied the effect of beta blockers non-withdrawal on intrahospital, 3-month and 12-month mortality and rehospitalisation for HF in patients with acute decompensated chronic heart failure (ADCHF) and acute de novo heart failure (ADNHF) and a left ventricular ejection fraction (LVEF) <40%. Results 44.1% of patients were already on beta blockers on inclusion. Among those, 57.8% had an LVEF <40%. Further, 79.9% were diagnosed with ADCHF and 20.4% with ADNHF. Mean age was 61 (SD 13.9) in the ADCHF group and 59.8 (SD 13.8) in the ADNHF group. Intrahospital mortality was lower in patients whose beta blocker therapy was not withdrawn in both the ADCHF and ADNHF groups. This protective effect persisted after multivariate analysis (OR 0.05, 95% CI 0.022 to 0.112; OR 0.018, 95% CI 0.003 to 0.122, respectively, p<0.001 for both) and propensity score matching even after correcting for variables that remained significant in the new model (OR 0.084, 95% CI 0.015 to 0.468, p=0.005; OR 0.047, 95% CI 0.013 to 0.169, p<0.001, respectively). At 3 months, mortality was still lower only in patients with ADCHF in whom beta blockers were maintained during initial hospitalisation. However, the benefit was lost after correcting for confounding factors. Interestingly, rehospitalisation for HF and length of hospital stay were unaffected by beta blockers discontinuation in all patients. Conclusion In summary, non-withdrawal of beta blockers in acute decompensated chronic and de novo heart failure with reduced ejection fraction is associated with lower intrahospital mortality but does not influence 3-month and 12-month mortality, rehospitalisation for heart failure,and the length of hospital stay. Trial registration number NCT01467973; Post-results.
| Original language | English |
|---|---|
| Article number | e014915 |
| Journal | BMJ Open |
| Volume | 7 |
| Issue number | 7 |
| DOIs | |
| Publication status | Published - 1 Jul 2017 |
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Keywords
- adult cardiology
- cardiac epidemiology
- heart failure
ASJC Scopus subject areas
- Medicine(all)
Cite this
Non-withdrawal of beta blockers in acute decompensated chronic and de novo heart failure with reduced ejection fraction in a prospective multicentre study of patients with acute heart failure in the Middle East. / Abi Khalil, Charbel; Sulaiman, Kadhim; Mahfoud, Ziyad; Singh, Rajvir; Asaad, Nidal; Alhabib, Khalid F.; Alsheikh-Ali, Alawi; Al-Jarallah, Mohammed; Bulbanat, Bassam; Almahmeed, Wael; Ridha, Mustafa; Bazargani, Nooshin; Amin, Haitham; Al-Motarreb, Ahmed; Faleh, Husam Al; Elasfar, Abdelfatah; Panduranga, Prashanth; Suwaidi, Jassim Al.
In: BMJ Open, Vol. 7, No. 7, e014915, 01.07.2017.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Non-withdrawal of beta blockers in acute decompensated chronic and de novo heart failure with reduced ejection fraction in a prospective multicentre study of patients with acute heart failure in the Middle East
AU - Abi Khalil, Charbel
AU - Sulaiman, Kadhim
AU - Mahfoud, Ziyad
AU - Singh, Rajvir
AU - Asaad, Nidal
AU - Alhabib, Khalid F.
AU - Alsheikh-Ali, Alawi
AU - Al-Jarallah, Mohammed
AU - Bulbanat, Bassam
AU - Almahmeed, Wael
AU - Ridha, Mustafa
AU - Bazargani, Nooshin
AU - Amin, Haitham
AU - Al-Motarreb, Ahmed
AU - Faleh, Husam Al
AU - Elasfar, Abdelfatah
AU - Panduranga, Prashanth
AU - Suwaidi, Jassim Al
PY - 2017/7/1
Y1 - 2017/7/1
N2 - Objectives Beta blockers reduce mortality in heart failure (HF). However, it is not clear whether they should be temporarily withdrawn during acute HF. Design Analysis of prospectively collected data. Setting The Gulf aCute heArt failuRe rEgistry is a prospective multicentre study of patients hospitalised with acute HF in seven Middle Eastern countries. Participants 5005 patients with acute HF. Outcome measures We studied the effect of beta blockers non-withdrawal on intrahospital, 3-month and 12-month mortality and rehospitalisation for HF in patients with acute decompensated chronic heart failure (ADCHF) and acute de novo heart failure (ADNHF) and a left ventricular ejection fraction (LVEF) <40%. Results 44.1% of patients were already on beta blockers on inclusion. Among those, 57.8% had an LVEF <40%. Further, 79.9% were diagnosed with ADCHF and 20.4% with ADNHF. Mean age was 61 (SD 13.9) in the ADCHF group and 59.8 (SD 13.8) in the ADNHF group. Intrahospital mortality was lower in patients whose beta blocker therapy was not withdrawn in both the ADCHF and ADNHF groups. This protective effect persisted after multivariate analysis (OR 0.05, 95% CI 0.022 to 0.112; OR 0.018, 95% CI 0.003 to 0.122, respectively, p<0.001 for both) and propensity score matching even after correcting for variables that remained significant in the new model (OR 0.084, 95% CI 0.015 to 0.468, p=0.005; OR 0.047, 95% CI 0.013 to 0.169, p<0.001, respectively). At 3 months, mortality was still lower only in patients with ADCHF in whom beta blockers were maintained during initial hospitalisation. However, the benefit was lost after correcting for confounding factors. Interestingly, rehospitalisation for HF and length of hospital stay were unaffected by beta blockers discontinuation in all patients. Conclusion In summary, non-withdrawal of beta blockers in acute decompensated chronic and de novo heart failure with reduced ejection fraction is associated with lower intrahospital mortality but does not influence 3-month and 12-month mortality, rehospitalisation for heart failure,and the length of hospital stay. Trial registration number NCT01467973; Post-results.
AB - Objectives Beta blockers reduce mortality in heart failure (HF). However, it is not clear whether they should be temporarily withdrawn during acute HF. Design Analysis of prospectively collected data. Setting The Gulf aCute heArt failuRe rEgistry is a prospective multicentre study of patients hospitalised with acute HF in seven Middle Eastern countries. Participants 5005 patients with acute HF. Outcome measures We studied the effect of beta blockers non-withdrawal on intrahospital, 3-month and 12-month mortality and rehospitalisation for HF in patients with acute decompensated chronic heart failure (ADCHF) and acute de novo heart failure (ADNHF) and a left ventricular ejection fraction (LVEF) <40%. Results 44.1% of patients were already on beta blockers on inclusion. Among those, 57.8% had an LVEF <40%. Further, 79.9% were diagnosed with ADCHF and 20.4% with ADNHF. Mean age was 61 (SD 13.9) in the ADCHF group and 59.8 (SD 13.8) in the ADNHF group. Intrahospital mortality was lower in patients whose beta blocker therapy was not withdrawn in both the ADCHF and ADNHF groups. This protective effect persisted after multivariate analysis (OR 0.05, 95% CI 0.022 to 0.112; OR 0.018, 95% CI 0.003 to 0.122, respectively, p<0.001 for both) and propensity score matching even after correcting for variables that remained significant in the new model (OR 0.084, 95% CI 0.015 to 0.468, p=0.005; OR 0.047, 95% CI 0.013 to 0.169, p<0.001, respectively). At 3 months, mortality was still lower only in patients with ADCHF in whom beta blockers were maintained during initial hospitalisation. However, the benefit was lost after correcting for confounding factors. Interestingly, rehospitalisation for HF and length of hospital stay were unaffected by beta blockers discontinuation in all patients. Conclusion In summary, non-withdrawal of beta blockers in acute decompensated chronic and de novo heart failure with reduced ejection fraction is associated with lower intrahospital mortality but does not influence 3-month and 12-month mortality, rehospitalisation for heart failure,and the length of hospital stay. Trial registration number NCT01467973; Post-results.
KW - adult cardiology
KW - cardiac epidemiology
KW - heart failure
UR - http://www.scopus.com/inward/record.url?scp=85022211427&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85022211427&partnerID=8YFLogxK
U2 - 10.1136/bmjopen-2016-014915
DO - 10.1136/bmjopen-2016-014915
M3 - Article
C2 - 28694343
AN - SCOPUS:85022211427
VL - 7
JO - BMJ Open
JF - BMJ Open
SN - 2044-6055
IS - 7
M1 - e014915
ER -