title: BETAWIN-AHF study: effect of beta-blocker withdrawal during acute decompensation in patients with chronic heart failure.
abstract: OBJECTIVE
  To evaluate the effects of discontinuing chronic beta-blocker (BB) treatment on short-term outcome in patients with chronic heart failure (CHF) during acute decompensation.
  
  
  METHODS
  We selected all the patients previously diagnosed with CHF and currently on BB and attended for acute heart failure (AHF) in one of the 35 Spanish emergency departments participating in the EAHFE registry. Patients were classified according to BB maintenance or withdrawal (BBM or BBW, respectively) during the episode. In-hospital mortality was the primary endpoint; and 30-day mortality, 30-day combined endpoint, and prolonged hospitalization were secondary. We used logistic regression for adjustment of results according to the differences between the BBM and BBW groups, and stratified analysis by age, sex, left ventricular ejection fraction, chronic obstructive pulmonary disease, heart rate (HR), and BB type (carvedilol/bisoprolol) was performed.
  
  
  RESULTS
  Among 2058 patients receiving chronic BB treatment, 1990 were analyzed: BBM 530 (27 %), BBW 1460 (73 %). Compared to BBM, BBW had a higher in-hospital mortality (5.5 vs 3.0 %; p < 0.05), 30-day mortality (8.7 vs 4.5 %; p < 0.01), and 30-day combined endpoint (29.8 vs 23.4 %; p < 0.05). Multivariate adjustment confirmed an independent direct association between BBW and in-hospital mortality (OR 1.89; 95 % CI 1.09-3.26) and 30-day mortality (OR 2.01; 95 % CI 1.28-3.15). Stratified analysis indicated no interaction by all the subgroups analyzed, except for HR (p = 0.01 for interaction), which showed a greater negative impact of BBW in patients with HR >80 bpm (OR 2.74; 95 % CI 1.13-6.63).
  
  
  CONCLUSIONS
  In the absence of clear contraindications, BB treatment should be maintained during AHF episodes in patients already receiving BB at home.
authors.affiliation: Emergency Department, Hospital Clínic, Villarroel 170, 08036, Barcelona, Catalonia, Spain. omiro@clinic.cat.|"Emergencies: Processes and Pathologies" Research Group, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain. omiro@clinic.cat.
authors.forename: Òscar
authors.initials: Ò
authors.lastname: Miró
authors.affiliation: Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Müller
authors.affiliation: Emergency Department, Hospital Clínico San Carlos, Madrid, Spain.|Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain.|Universidad Complutense de Madrid, Madrid, Spain.
authors.forename: Francisco Javier
authors.initials: FJ
authors.lastname: Martín-Sánchez
authors.affiliation: Universidad Complutense de Madrid, Madrid, Spain.|Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.|Instituto de Investigación i+12 y Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain.
authors.forename: Héctor
authors.initials: H
authors.lastname: Bueno
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Hospital Lariboisière, Université Paris Diderot, Paris, France.
authors.forename: Alexander
authors.initials: A
authors.lastname: Mebazaa
authors.affiliation: Emergency Department, Hospital Universitario Central de Asturias, Oviedo, Spain.
authors.forename: Pablo
authors.initials: P
authors.lastname: Herrero
authors.affiliation: Emergency Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Jacob
authors.affiliation: Emergency Department, Hospital Clínic, Villarroel 170, 08036, Barcelona, Catalonia, Spain.|"Emergencies: Processes and Pathologies" Research Group, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.
authors.forename: Víctor
authors.initials: V
authors.lastname: Gil
authors.affiliation: Emergency Department, Hospital Clínic, Villarroel 170, 08036, Barcelona, Catalonia, Spain.|"Emergencies: Processes and Pathologies" Research Group, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.
authors.forename: Rosa
authors.initials: R
authors.lastname: Escoda
authors.affiliation: Emergency Department, Home Hospitalization and Short Stay Unit, Hospital General de Alicante, Alicante, Spain.
authors.forename: Pere
authors.initials: P
authors.lastname: Llorens
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage* / Q000009:adverse effects; D000368:Aged; D000369:Aged, 80 and over; D017298:Bisoprolol / Q000008:administration & dosage* / Q000009:adverse effects; D002227:Carbazoles / Q000008:administration & dosage* / Q000009:adverse effects; D000077261:Carvedilol; D016009:Chi-Square Distribution; D002908:Chronic Disease; D004334:Drug Administration Schedule; D004636:Emergency Service, Hospital; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D011412:Propanolamines / Q000008:administration & dosage* / Q000009:adverse effects; D012042:Registries; D012307:Risk Factors; D013030:Spain; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists; D002227:Carbazoles; D011412:Propanolamines; D000077261:Carvedilol; D017298:Bisoprolol
keywords: Acute heart failure; Beta-blockers; Heart failure; Mortality; Outcome; Readmission