[Is it necessary to suspend betablockers in decompensated heart failure with low output?].
BACKGROUND
there is evidence that the suspension of betablockers (BB) in decompensated heart failure may increase mortality. Dobutamine (dobuta) is the most commonly used inotrope in decompensation, however, BB and dobuta act with the same receptor with antagonist actions, and concurrent use of both drugs could hinder compensation.


OBJECTIVE
to evaluate whether the maintenance of BB associated with dobuta difficults cardiac compensation.


METHODS
we studied 44 patients with LVEF < 45% and the need for inotropics. Divided into three groups according to the use of BB. Group A (n=8): those who were not using BB at baseline; Group B (n=25): those who used BB, but was suspended to start dobuta; Group C (n = 11): those who used BB concomitant to dobuta. To compare groups, we used the Student t, Fisher exact and chi-square tests. Considered significant if p < 0.05.


RESULTS
mean LVEF 23.8 ± 6.6%. The average use of dobuta use was similar in all groups (p = 0.35), and concomitant use of dobutamine with BB did not increase the length of stay (BB 20.36 ± 11.04 days vs without BB 28.37 ± 12.76 days, p = NS). In the high dose, BB was higher in patients whose medication was not suspended (35.8 ± 16.8 mg/day vs 23.0 ± 16.7 mg/day, p = 0.004).


CONCLUSIONS
maintaining BB associated with dobutamine did not increase the length of hospitalization and was not associated with the worst outcome. Patients who did not suspend BB were discharged with higher doses of the drug.
Lima
Marcelo Villaça
MV
Instituto do Coração, Faculdade de Medicina, USP, São Paulo, SP, Brasil. villacalima@cardiol.br
Cardoso
Juliano Novaes
JN
Ochiai
Marcelo Eidi
ME
Grativvol
Katiuska Massucatti
KM
Grativvol
Petherson Susano
PS
Brancalhão
Euler C O
EC
Munhoz
Robinson Tadeu
RT
Morgado
Paulo Cesar
PC
Scipioni
Airton R
AR
Barretto
Antonio Carlos Pereira
AC
D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage / Q000009:adverse effects* / Q000378:metabolism; D002303:Cardiac Output, Low / Q000150:complications / Q000188:drug therapy; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D004280:Dobutamine / Q000627:therapeutic use*; D004359:Drug Therapy, Combination / Q000009:adverse effects; D005260:Female; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D028761:Withholding Treatment
D000319:Adrenergic beta-Antagonists; D002316:Cardiotonic Agents; D004280:Dobutamine