Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease (Jul 2021)

Lower In‐Hospital Mortality With Beta‐Blocker Use at Admission in Patients With Acute Decompensated Heart Failure

  • Yodo Tamaki,
  • Hidenori Yaku,
  • Takeshi Morimoto,
  • Yasutaka Inuzuka,
  • Neiko Ozasa,
  • Erika Yamamoto,
  • Yusuke Yoshikawa,
  • Makoto Miyake,
  • Hirokazu Kondo,
  • Toshihiro Tamura,
  • Takeshi Kitai,
  • Moritake Iguchi,
  • Kazuya Nagao,
  • Ryusuke Nishikawa,
  • Yuichi Kawase,
  • Takashi Morinaga,
  • Mitsunori Kawato,
  • Mamoru Toyofuku,
  • Yukihito Sato,
  • Koichiro Kuwahara,
  • Yoshihisa Nakagawa,
  • Takao Kato,
  • Takeshi Kimura

DOI
https://doi.org/10.1161/JAHA.120.020012
Journal volume & issue
Vol. 10, no. 13

Abstract

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Background It remains unclear whether beta‐blocker use at hospital admission is associated with better in‐hospital outcomes in patients with acute decompensated heart failure. Methods and Results We evaluated the factors independently associated with beta‐blocker use at admission, and the effect of beta‐blocker use at admission on in‐hospital mortality in 3817 patients with acute decompensated heart failure enrolled in the Kyoto Congestive Heart Failure registry. There were 1512 patients (39.7%) receiving, and 2305 patients (60.3%) not receiving beta‐blockers at admission for the index acute decompensated heart failure hospitalization. Factors independently associated with beta‐blocker use at admission were previous heart failure hospitalization, history of myocardial infarction, atrial fibrillation, cardiomyopathy, and estimated glomerular filtration rate <30 mL/min per 1.73 m2. Factors independently associated with no beta‐blocker use were asthma, chronic obstructive pulmonary disease, lower body mass index, dementia, older age, and left ventricular ejection fraction <40%. Patients on beta‐blockers had significantly lower in‐hospital mortality rates (4.4% versus 7.6%, P<0.001). Even after adjusting for confounders, beta‐blocker use at admission remained significantly associated with lower in‐hospital mortality risk (odds ratio, 0.41; 95% CI, 0.27–0.60, P<0.001). Furthermore, beta‐blocker use at admission was significantly associated with both lower cardiovascular mortality risk and lower noncardiovascular mortality risk. The association of beta‐blocker use with lower in‐hospital mortality risk was relatively more prominent in patients receiving high dose beta‐blockers. The magnitude of the effect of beta‐blocker use was greater in patients with previous heart failure hospitalization than in patients without (P for interaction 0.04). Conclusions Beta‐blocker use at admission was associated with lower in‐hospital mortality in patients with acute decompensated heart failure. Registration URL: https://www.upload.umin.ac.jp/; Unique identifier: UMIN000015238.

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