B-CONVINCED: Beta-blocker CONtinuation Vs. INterruption in patients with Congestive heart failure hospitalizED for a decompensation episode.
OBJECTIVE
Whether or not beta-blocker therapy should be stopped during acutely decompensated heart failure (ADHF) is unsure.


RESULTS
In a randomized, controlled, open labelled, non-inferiority trial, we compared beta-blockade continuation vs. discontinuation during ADHF in patients with LVEF below 40% previously receiving stable beta-blocker therapy. 169 patients were included, among which 147 were evaluable. Mean age was 72 +/- 12 years, 65% were males. After 3 days, 92.8% of patients pursuing beta-blockade improved for both dyspnoea and general well-being according to a physician blinded for therapy vs. 92.3% of patients stopping beta-blocker. This was the main endpoint and the upper limit for unilateral 95% CI (6.6%) is lower that of the predefined upper limit (12.5%), indicating non-inferiority. Similar findings were obtained at 8 days and when evaluation was made by the patient. Plasma BNP at Day 3, length of hospital stay, re-hospitalization rate, and death rate after 3 months were also similar. Beta-blocker therapy at 3 months was given to 90% of patients vs. 76% (P < 0.05).


CONCLUSIONS
In conclusion, during ADHF, continuation of beta-blocker therapy is not associated with delayed or lesser improvement, but with a higher rate of chronic prescription of beta-blocker therapy after 3 months, the benefit of which is well established.
Jondeau
Guillaume
G
AP-HP, Hôpital Bichat, Service de Cardiologie, Faculté de médecine Paris VII, INSERM U698, Paris F-75018, France. guillaume.jondeau@bch.aphp.fr
Neuder
Yannick
Y
Eicher
Jean-Christophe
JC
Jourdain
Patrick
P
Fauveau
Elodie
E
Galinier
Michel
M
Jegou
Arnaud
A
Bauer
Fabrice
F
Trochu
Jean Noel
JN
Bouzamondo
Anissa
A
Tanguy
Marie-Laure
ML
Lechat
Philippe
P
D000293:Adolescent; D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage*; D000328:Adult; D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D018450:Disease Progression; D004417:Dyspnea / Q000209:etiology / Q000517:prevention & control; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000503:physiopathology; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D013318:Stroke Volume / Q000502:physiology; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000188:drug therapy / Q000503:physiopathology; D028761:Withholding Treatment; D055815:Young Adult
D000319:Adrenergic beta-Antagonists