title: Influence of beta-blocker continuation or withdrawal on outcomes in patients hospitalized with heart failure: findings from the OPTIMIZE-HF program.
abstract: OBJECTIVE
  This study ascertains the relationship between continuation or withdrawal of beta-blocker therapy and clinical outcomes in patients hospitalized with systolic heart failure (HF).
  
  
  BACKGROUND
  Whether beta-blocker therapy should be continued or withdrawn during hospitalization for decompensated HF has not been well studied in a broad cohort of patients.
  
  
  METHODS
  The OPTIMIZE-HF (Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure) program enrolled 5,791 patients admitted with HF in a registry with pre-specified 60- to 90-day follow-up at 91 academic and community hospitals throughout the U.S. Outcomes data were prospectively collected and analyzed according to whether beta-blocker therapy was continued, withdrawn, or not started.
  
  
  RESULTS
  Among 2,373 patients eligible for beta-blockers at discharge, there were 1,350 (56.9%) who were receiving beta-blockers before admission and continued on therapy, 632 (26.6%) newly started, 79 (3.3%) in which therapy was withdrawn, and 303 (12.8%) eligible but not treated. Continuation of beta-blockers was associated with a significantly lower risk and propensity adjusted post-discharge death (hazard ratio [HR]: 0.60; 95% confidence interval [CI]: 0.37 to 0.99, p = 0.044) and death/rehospitalization (odds ratio: 0.69; 95% CI: 0.52 to 0.92, p = 0.012) compared with no beta-blocker. In contrast, withdrawal of beta-blocker was associated with a substantially higher adjusted risk for mortality compared with those continued on beta-blockers (HR: 2.3; 95% CI: 1.2 to 4.6, p = 0.013), but with similar risk as HF patients eligible but not treated with beta-blockers.
  
  
  CONCLUSIONS
  The continuation of beta-blocker therapy in patients hospitalized with decompensated HF is associated with lower post-discharge mortality risk and improved treatment rates. In contrast, withdrawal of beta-blocker therapy is associated with worse risk and propensity-adjusted mortality. (Organized Program To Initiate Lifesaving Treatment In Hospitalized Patients With Heart Failure [OPTIMIZE-HF]; NCT00344513).
authors.affiliation: Department of Medicine, University of California-Los Angeles Medical Center, Los Angeles, California 90095-1679, USA. gfonarow@mednet.ucla.edu
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.forename: William T
authors.initials: WT
authors.lastname: Abraham
authors.forename: Nancy M
authors.initials: NM
authors.lastname: Albert
authors.forename: Wendy Gattis
authors.initials: WG
authors.lastname: Stough
authors.forename: Mihai
authors.initials: M
authors.lastname: Gheorghiade
authors.forename: Barry H
authors.initials: BH
authors.lastname: Greenberg
authors.forename: Christopher M
authors.initials: CM
authors.lastname: O'Connor
authors.forename: Jie Lena
authors.initials: JL
authors.lastname: Sun
authors.forename: Clyde W
authors.initials: CW
authors.lastname: Yancy
authors.forename: James B
authors.initials: JB
authors.lastname: Young
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage*; D000368:Aged; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality*; D006760:Hospitalization; D006801:Humans; D008297:Male; D016017:Odds Ratio; D015397:Program Evaluation; D011446:Prospective Studies; D011786:Quality Control; D012042:Registries; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D028761:Withholding Treatment
chemical_list: D000319:Adrenergic beta-Antagonists