title: Beta-blockers Associated with a Mortality Benefit in Patients with Systolic Dysfunction and Elevated Serum Bilirubin.
abstract: BACKGROUND
  Hyperbilirubinemia is associated with increased mortality in heart failure (HF) patients. We evaluated the impact of evidence-based medical therapy, in particular beta-blocker on the survival of patients with HF and hyperbilirubinemia.
  
  
  RESULTS
  We reviewed the charts of all patients followed at our tertiary care heart failure clinic. Hyperbilirubinemia was defined as total bilirubin >30 µmol/L (1.5 times the upper limit of our laboratory value). The primary endpoint was all-cause mortality. The secondary endpoint was a composite of death, cardiac transplant or ventricular assistance device implantation (VAD). Of 1035 HF patients, 121 patients (11.7%) had hyperbilirubinemia. Median follow-up was 556 days. Hyperbilirubinemia was associated with an eight-fold increase in all-cause mortality, hazard ratio (HR): 8.78[95% Confidence Intervals (CI): 5.89-13.06]. Beta-blocker use was associated with approximately 60% reduction in all-cause mortality (HR: 0.38, 95% CI:0.15-0.94) and 70% reduction in the composite secondary endpoint (HR:0.31, 95% CI:0.13-0.71) in patients with hyperbilirubinemia.
  
  
  CONCLUSIONS
  HF patients with hyperbilirubinemia have increased early mortality, need for cardiac transplantation or VAD. Beta-blocker use was associated with early survival benefit in these patients. Bilirubin levels should be monitored in patients with HF and early initiation of beta-blockers in patients with hyperbilirubinemia should be considered.
authors.affiliation: Division of Epidemiology, Biostatistics and Occupational Health, McGill University.
authors.forename: Christopher
authors.initials: C
authors.lastname: Labos
authors.affiliation: Division of Epidemiology, Biostatistics and Occupational Health, McGill University.
authors.forename: Vivian
authors.initials: V
authors.lastname: Nguyen
authors.affiliation: Division of Epidemiology, Biostatistics and Occupational Health, McGill University.
authors.forename: Nadia
authors.initials: N
authors.lastname: Giannetti
authors.affiliation: Division of Epidemiology, Biostatistics and Occupational Health, McGill University.
authors.forename: Thao
authors.initials: T
authors.lastname: Huynh
keywords: Beta-blockers; bilirubin; heart Failure; prognosis