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Evaluation of ?-blocker therapy for long-term outcomes in patients with low ejection fraction after cardiac surgery.

ABSTRACT: BACKGROUND:Preoperative low left ventricular ejection fraction (LVEF) has been reported as an independent risk factor for in-hospital mortality. However, there were few studies evaluating the long-term mortality in these patients. We, therefore, conducted this study to investigate long-term outcomes of surgery on patients with LVEF?35% undergoing a broad range of cardiac procedures. METHODS:We performed a retrospective cohort study in 510 patients from January 1, 2007 to September 1, 2019. These patients were divided into survival group (n?=?386) and non-survival group (n?=?124). The multivariate Cox analysis was used to estimate the risk factors for survival. In Cox analysis, ?-blockers were indicated to be associated with long-term mortality. To further address bias, we derived a propensity score predicting the function of ?-blockers on survival, and matched 52 cases to 52 controls with similar risk profiles. RESULTS:Patients were followed for a median period of 24?months (interquartile range: 11-44?months). Multivariate Cox regression analysis indicated that the non-survival group had higher weight, higher EuroSCORE, more smoking patients, longer time of cardiopulmonary bypass (CPB), more intra-aortic balloon pump (IABP) use, and more patients who always used ?-blocker (HR: 2.056, 95%CI:1.236-3.420, P?=?0.005) compared with survival group. After propensity matching, the group which always used ?-blocker showed higher rate of all-cause death compare with the control group (61.54% vs 80.77%, P?=?0.030). CONCLUSIONS:The risk factors for long-term survival were weight, EuroSCORE, smoking, CPB, IABP, always used ?-blockers in patients with LVEF?35%. The discharge prescription of ?-blocker should be cautiously administrated in those patients.

SUBMITTER: Fan FD

PROVIDER: S-EPMC7439680 | biostudies-literature | 2020 Aug

REPOSITORIES: biostudies-literature

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Evaluation of β-blocker therapy for long-term outcomes in patients with low ejection fraction after cardiac surgery.

Fan Fu-Dong FD Zhang Hai-Tao HT Pan Tuo T Tang Xin-Long XL Wang Dong-Jin DJ

BMC cardiovascular disorders 20200820 1

<h4>Background</h4>Preoperative low left ventricular ejection fraction (LVEF) has been reported as an independent risk factor for in-hospital mortality. However, there were few studies evaluating the long-term mortality in these patients. We, therefore, conducted this study to investigate long-term outcomes of surgery on patients with LVEF≤35% undergoing a broad range of cardiac procedures.<h4>Methods</h4>We performed a retrospective cohort study in 510 patients from January 1, 2007 to September ...[more]

PMID: 32819270

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Project description:OBJECTIVES:The aim of this study was to analyse baseline characteristics and outcome of patients with heart failure and mid-range left ventricular ejection fraction (HFmrEF, left ventricular ejection fraction (LVEF) 40%-49%) and the effect of 1-year change in LVEF in this group. SETTING:Multicentre prospective observational study of ambulatory patients with HF followed up at four university hospitals with dedicated HF units. PARTICIPANTS:Fourteen per cent (n=504) of the 3580 patients included had HFmrEF. INTERVENTIONS:Baseline characteristics, 1-year LVEF and outcomes were collected. All-cause death, HF hospitalisation and the composite end-point were the primary outcomes. RESULTS:Median follow-up was 3.66 (1.69-6.04) years. All-cause death, HF hospitalisation and the composite end-point were 47%, 35% and 59%, respectively. Outcomes were worse in HF with preserved ejection fraction (HFpEF) (LVEF>50%), without differences between HF with reduced ejection fraction (HFrEF) (LVEF<40%) and HFmrEF (all-cause mortality 52.6% vs 45.8% and 43.8%, respectively, P=0.001). After multivariable Cox regression analyses, no differences in all-cause death and the composite end-point were seen between the three groups. HF hospitalisation and cardiovascular death were not statistically different between patients with HFmrEF and HFrEF. At 1-year follow-up, 62% of patients with HFmrEF had LVEF measured: 24% had LVEF<40%, 43% maintained LVEF 40%-49%?and 33% had LVEF>50%. While change in LVEF as continuous variable was not associated with better outcomes, those patients who evolved from HFmrEF to HFpEF did have a better outcome. Those who remained in the HFmrEF and HFrEF groups had higher all-cause mortality after adjustment for age, sex and baseline LVEF (HR 1.96 (95% CI 1.08 to 3.54, P=0.027)?and HR 2.01 (95% CI 1.04 to 3.86, P=0.037), respectively). CONCLUSIONS:Patients with HFmrEF have a clinical profile in-between HFpEF and HFrEF, without differences in all-cause mortality and the composite end-point between the three groups. At 1?year, patients with HFmrEF exhibited the greatest variability in LVEF and this change was associated with survival.

Dataset Information

Evaluation of ?-blocker therapy for long-term outcomes in patients with low ejection fraction after cardiac surgery.

Publications

Evaluation of β-blocker therapy for long-term outcomes in patients with low ejection fraction after cardiac surgery.

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