title: Clinical outcomes in patients on beta-blocker therapy admitted with worsening chronic heart failure.
abstract: Beta blockers have been shown to reduce morbidity and mortality in patients with heart failure without evidence of overt congestion. No data are available describing outcomes of patients admitted with exacerbated chronic heart failure who are receiving beta blockade at the time of admission. The purpose of this analysis was to evaluate clinical outcomes in patients from the Outcomes of the Prospective Trial of Intravenous Milrinone for Exacerbations of Chronic Heart Failure (OPTIME-CHF) study who were prescribed beta blockers on admission compared with patients who were not prescribed beta blockers at admission. In all, 212 patients were treated with beta blockers at admission and 737 patients were not. Baseline characteristics were similar between groups, except that patients prescribed beta blockers on admission had slightly higher ejection fractions, fewer New York Heart Association class IV symptoms, and lower heart rates. There was no difference in clinical events between patients who were treated with beta blockers at the time of admission and those who were not. Exploratory analyses suggested that patients whose beta-blocker therapy was discontinued had a higher risk of adverse outcomes, particularly in the subset of patients randomized to milrinone. The data from this nonrandom comparison suggest that continuation of pre-existing beta-blocker therapy is not associated with an increased risk of adverse clinical events in patients admitted with worsening heart failure. These results also suggest that caution should be taken when withdrawing beta blockade in this population.
authors.affiliation: Duke University Medical Center/Duke Clinical Research Institute, Division of Cardiology, Durham, North Carolina 27705, USA. wendy.gattis@duke.edu
authors.forename: Wendy A
authors.initials: WA
authors.lastname: Gattis
authors.forename: Christopher M
authors.initials: CM
authors.lastname: O'Connor
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Leimberger
authors.forename: G Michael
authors.initials: GM
authors.lastname: Felker
authors.forename: Kirkwood F
authors.initials: KF
authors.lastname: Adams
authors.forename: Mihai
authors.initials: M
authors.lastname: Gheorghiade
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D002227:Carbazoles / Q000627:therapeutic use; D002316:Cardiotonic Agents / Q000627:therapeutic use; D000077261:Carvedilol; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000503:physiopathology; D006339:Heart Rate; D006801:Humans; D008297:Male; D008790:Metoprolol / Q000627:therapeutic use; D008875:Middle Aged; D020105:Milrinone / Q000627:therapeutic use; D011412:Propanolamines / Q000627:therapeutic use; D013318:Stroke Volume; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists; D002227:Carbazoles; D002316:Cardiotonic Agents; D011412:Propanolamines; D000077261:Carvedilol; D008790:Metoprolol; D020105:Milrinone