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Non-withdrawal of beta blockers in acute decompensated chronic and de novo heart failure with reduced ejection fraction in a prospective multicentre study of patients with acute heart failure in the Middle East.

ABSTRACT: OBJECTIVES:Beta blockers reduce mortality in heart failure (HF). However, it is not clear whether they should be temporarily withdrawn during acute HF. DESIGN:Analysis of prospectively collected data. SETTING:The Gulf aCute heArt failuRe rEgistry is a prospective multicentre study of patients hospitalised with acute HF in seven Middle Eastern countries. PARTICIPANTS:5005 patients with acute HF. OUTCOME MEASURES:We studied the effect of beta blockers non-withdrawal on intrahospital, 3-month and 12-month mortality and rehospitalisation for HF in patients with acute decompensated chronic heart failure (ADCHF) and acute de novo heart failure (ADNHF) and a left ventricular ejection fraction (LVEF) <40%. RESULTS:44.1% of patients were already on beta blockers on inclusion. Among those, 57.8% had an LVEF <40%. Further, 79.9% were diagnosed with ADCHF and 20.4% with ADNHF. Mean age was 61 (SD 13.9) in the ADCHF group and 59.8 (SD 13.8) in the ADNHF group. Intrahospital mortality was lower in patients whose beta blocker therapy was not withdrawn in both the ADCHF and ADNHF groups. This protective effect persisted after multivariate analysis (OR 0.05, 95%?CI 0.022 to 0.112; OR 0.018, 95%?CI 0.003 to 0.122, respectively, p<0.001 for both) and propensity score matching even after correcting for variables that remained significant in the new model (OR 0.084, 95%?CI 0.015 to 0.468, p=0.005; OR 0.047, 95%?CI 0.013 to 0.169, p<0.001, respectively). At 3 months, mortality was still lower only in patients with ADCHF in whom beta blockers were maintained during initial hospitalisation. However, the benefit was lost after correcting for confounding factors. Interestingly, rehospitalisation for HF and length of hospital stay were unaffected by beta blockers discontinuation in all patients. CONCLUSION:In summary, non-withdrawal of beta blockers in acute decompensated chronic and de novo heart failure with reduced ejection fraction is associated with lower intrahospital mortality but does not influence 3-month and 12-month mortality, rehospitalisation for heart failure,and the length of hospital stay. TRIAL REGISTRATION NUMBER:NCT01467973; Post-results.

SUBMITTER: Abi Khalil C

PROVIDER: S-EPMC5734353 | biostudies-literature | 2017 Jul

REPOSITORIES: biostudies-literature

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Non-withdrawal of beta blockers in acute decompensated chronic and de novo heart failure with reduced ejection fraction in a prospective multicentre study of patients with acute heart failure in the Middle East.

Abi Khalil Charbel C Sulaiman Kadhim K Mahfoud Ziyad Z Singh Rajvir R Asaad Nidal N AlHabib Khalid F KF Alsheikh-Ali Alawi A Al-Jarallah Mohammed M Bulbanat Bassam B AlMahmeed Wael W Ridha Mustafa M Bazargani Nooshin N Amin Haitham H Al-Motarreb Ahmed A Faleh Husam Al HA Elasfar Abdelfatah A Panduranga Prashanth P Suwaidi Jassim Al JA

BMJ open 20170709 7

<h4>Objectives</h4>Beta blockers reduce mortality in heart failure (HF). However, it is not clear whether they should be temporarily withdrawn during acute HF.<h4>Design</h4>Analysis of prospectively collected data.<h4>Setting</h4>The Gulf aCute heArt failuRe rEgistry is a prospective multicentre study of patients hospitalised with acute HF in seven Middle Eastern countries.<h4>Participants</h4>5005 patients with acute HF.<h4>Outcome measures</h4>We studied the effect of beta blockers non-withdr ...[more]

PMID: 28694343

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Project description:Background Although the prognostic importance of pulmonary arterial capacitance (PAC; stroke volume/pulmonary arterial pulse pressure) has been elucidated in heart failure with reduced ejection fraction, whether its significance in patients suffering from heart failure with preserved ejection fraction is not known. We aimed to examine the association of PAC with outcomes in inpatients with heart failure with preserved ejection fraction. Methods and Results We prospectively studied 705 patients (median age, 83 years; 55% women) registered in PURSUIT-HFpEF (Prospective Multicenter Observational Study of Patients With Heart Failure With Preserved Ejection Fraction). We investigated the association of echocardiographic PAC at discharge with the primary end point of all-cause death or heart failure rehospitalization with a mean follow-up of 384 days. We further tested the acceptability of the prognostic significance of PAC in a subgroup of patients (167/705 patients; median age, 81 years; 53% women) in whom PAC was assessed by right heart catheterization. The median echocardiographic PAC was 2.52 mL/mm Hg, with a quartile range of 1.78 to 3.32 mL/mm Hg. Univariable and multivariable Cox regression testing revealed that echocardiographic PAC was associated with the primary end point (unadjusted hazard ratio, 0.82; 95% CI, 0.72-0.92; P=0.001; adjusted hazard ratio, 0.86; 95% CI, 0.74-0.99; P=0.035, respectively). Univariable Cox regression testing revealed that PAC assessed by right heart catheterization (median calculated PAC, 2.82 mL/mm Hg) was also associated with the primary end point (unadjusted HR, 0.70; 95% CI, 0.52-0.91; P=0.005). Conclusions A prospective cohort study revealed that impaired PAC diagnosed with both echocardiography and right heart catheterization was associated with adverse outcomes in inpatients with heart failure with preserved ejection fraction. Registration URL: https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000024414. Unique identifier: UMIN000021831.

Dataset Information

Non-withdrawal of beta blockers in acute decompensated chronic and de novo heart failure with reduced ejection fraction in a prospective multicentre study of patients with acute heart failure in the Middle East.

Publications

Non-withdrawal of beta blockers in acute decompensated chronic and de novo heart failure with reduced ejection fraction in a prospective multicentre study of patients with acute heart failure in the Middle East.

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