title: Effects of Beta-Blocker Withdrawal in Acute Decompensated Heart Failure: A Systematic Review and Meta-Analysis.
abstract: OBJECTIVE
  This study sought to evaluate the effects of beta-blocker withdrawal in acute decompensated heart failure (ADHF).
  
  
  BACKGROUND
  Published reports showed trends for either no harm or increased risk of in-hospital mortality, short-term mortality, and rehospitalization rates in patients admitted for ADHF that discontinued beta-blockers; however, a comprehensive analysis has not been conducted.
  
  
  METHODS
  Relevant studies from January 2000 through January 2015 were identified in the PubMed, EMBASE, and COCHRANE electronic databases. Where appropriate data were available, weighted relative risks were estimated using random-effects meta-analysis techniques.
  
  
  RESULTS
  Five observational studies and 1 randomized clinical trial (n = 2,704 patients who continued beta-blocker therapy and n = 439 patients who discontinued beta-blocker therapy) that reported the short-term effects of beta-blocker withdrawal in ADHF were included in the analyses. In 2 studies, beta-blocker withdrawal significantly increased risk of in-hospital mortality (risk ratio: 3.72; 95% confidence interval [CI]: 1.51 to 9.14). Short-term mortality (relative risk: 1.61; 95% CI: 1.04 to 2.49; 4 studies) and combined short-term rehospitalization or death (relative risk: 1.59; 95% CI: 1.03 to 2.45; 4 studies) were also significantly increased.
  
  
  CONCLUSIONS
  Discontinuation of beta-blockers in patients admitted with ADHF was associated with significantly increased in-hospital mortality, short-term mortality, and the combined endpoint of short-term rehospitalization or mortality. These data suggest beta-blockers should be continued in ADHF patients if their clinical picture allows.
authors.affiliation: Cardiovascular Division, University of Minnesota Medical School, Minneapolis, Minnesota. Electronic address: prin0088@umn.edu.
authors.forename: Kurt W
authors.initials: KW
authors.lastname: Prins
authors.affiliation: Department of Internal Medicine, University of Alabama-Birmingham, Birmingham, Alabama.
authors.forename: John M
authors.initials: JM
authors.lastname: Neill
authors.affiliation: Department of Internal Medicine, University of Alabama-Birmingham, Birmingham, Alabama.
authors.forename: John O
authors.initials: JO
authors.lastname: Tyler
authors.affiliation: Cardiovascular Division, University of Minnesota Medical School, Minneapolis, Minnesota.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Eckman
authors.affiliation: Cardiovascular Division, University of Minnesota Medical School, Minneapolis, Minnesota.
authors.forename: Sue
authors.initials: S
authors.lastname: Duval
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000009:adverse effects* / Q000627:therapeutic use*; D006333:Heart Failure / Q000139:chemically induced* / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D064887:Observational Studies as Topic; D016032:Randomized Controlled Trials as Topic; D013375:Substance Withdrawal Syndrome / Q000175:diagnosis*; D015996:Survival Rate
chemical_list: D000319:Adrenergic beta-Antagonists
keywords: acute decompensated heart failure; beta-blockers; meta-analysis