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

Charbel Abi Khalil, Kadhim Sulaiman, Ziyad Mahfoud, Rajvir Singh, Nidal Asaad, Khalid F. Alhabib, Alawi Alsheikh-Ali, Mohammed Al-Jarallah, Bassam Bulbanat, Wael Almahmeed, Mustafa Ridha, Nooshin Bazargani, Haitham Amin, Ahmed Al-Motarreb, Husam Al Faleh, Abdelfatah Elasfar, Prashanth Panduranga, Jassim Al Suwaidi

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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 However, it is not clear whether they should be temporarily withdrawn during acute HF.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 Intrahospital mortality was lower in patients whose beta blocker therapy was not withdrawn in both the ADCHF and ADNHF groups.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 languageEnglish
Article numbere014915
JournalBMJ Open
Volume7
Issue number7
DOIs
Publication statusPublished - 1 Jul 2017

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Middle East
Multicenter Studies
Heart Failure
Prospective Studies
Mortality
Length of Stay
Stroke Volume
Propensity Score

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 journalArticle

Abi Khalil, C, Sulaiman, K, Mahfoud, Z, Singh, R, Asaad, N, Alhabib, KF, Alsheikh-Ali, A, Al-Jarallah, M, Bulbanat, B, Almahmeed, W, Ridha, M, Bazargani, N, Amin, H, Al-Motarreb, A, Faleh, HA, Elasfar, A, Panduranga, P & Suwaidi, JA 2017, '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', BMJ Open, vol. 7, no. 7, e014915. https://doi.org/10.1136/bmjopen-2016-014915
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. / 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. In: BMJ Open. 2017 ; Vol. 7, No. 7.
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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.",
keywords = "adult cardiology, cardiac epidemiology, heart failure",
author = "{Abi Khalil}, Charbel and Kadhim Sulaiman and Ziyad Mahfoud and Rajvir Singh and Nidal Asaad and Alhabib, {Khalid F.} and Alawi Alsheikh-Ali and Mohammed Al-Jarallah and Bassam Bulbanat and Wael Almahmeed and Mustafa Ridha and Nooshin Bazargani and Haitham Amin and Ahmed Al-Motarreb and Faleh, {Husam Al} and Abdelfatah Elasfar and Prashanth Panduranga and Suwaidi, {Jassim Al}",
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month = "7",
day = "1",
doi = "10.1136/bmjopen-2016-014915",
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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

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U2 - 10.1136/bmjopen-2016-014915

DO - 10.1136/bmjopen-2016-014915

M3 - Article

VL - 7

JO - BMJ Open

JF - BMJ Open

SN - 2044-6055

IS - 7

M1 - e014915

ER -