Effect of beta-blocker use on outcomes after discharge in patients who underwent cardiac surgery.
OBJECTIVE
Beta-blockers improve outcomes in patients with heart failure or a history of myocardial infarction, but it remains uncertain whether they are beneficial after the perioperative period in cardiac surgery patients without these conditions. This study was designed to examine whether discharge use of beta-blockers was associated with outcomes after hospitalization in patients who had undergone nontransplant cardiac surgery.


METHODS
We analyzed outcomes in a prospective cohort of 3102 patients discharged alive after cardiac surgery (2547 of whom had undergone coronary artery bypass grafting surgery) between September 2002 and August 2005.


RESULTS
Beta-blockers were prescribed for 2580 (83%) patients at hospital discharge. Over a mean follow-up of 75 months (standard deviation, 20 months), 10% (259/2580) of patients discharged with beta-blockers and 19% (97/522) not prescribed beta-blockers at the time of hospital discharge died (hazard ratio of 0.65 [95% confidence interval, 0.49-0.87] after adjustment for covariates). One-year mortality was also lower in those discharged with beta-blockers: 2.2% (57/2580) in beta-blocker users versus 7.2% (38/522) in nonusers (adjusted odds ratio, 0.54 [95% confidence interval, 0.30-0.97]). The association between beta-blocker use and lower mortality was consistent across all examined subgroups, including patients without prior myocardial infarction or without heart failure (all P < .01).


CONCLUSIONS
Patients discharged with beta-blockers after cardiac surgery exhibit a substantially lower mortality rate during long-term follow-up, even among those without a history of myocardial infarction or heart failure.
Chan
Anita Y M
AY
Division of General Internal Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
McAlister
Finlay A
FA
Norris
Colleen M
CM
Johnstone
David
D
Bakal
Jeffrey A
JA
Ross
David B
DB
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D000416:Alberta; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004363:Drug Utilization; D005260:Female; D006331:Heart Diseases / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D010351:Patient Discharge / Q000706:statistics & numerical data*; D019990:Perioperative Care; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome
D000319:Adrenergic beta-Antagonists