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CLINICAL RESEARCH: HEART FAILURE

Beta-Blocker Use and Outcomes Among Hospitalized Heart Failure Patients

Javed Butler, MD^_*,_*, James B. Young, MD, William T. Abraham, MD, Robert C. Bourge, MD, Kirkwood F. Adams, Jr, MD^||, Robert Clare, MS^¶, Christopher O’Connor, MD^# for the ESCAPE Investigators

^_* Cardiovascular Medicine Division, Vanderbilt University, Nashville, Tennessee
Department of Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
Cardiology Division, Ohio State University, Columbus, Ohio
Division of Cardiovascular Disease, University of Alabama, Birmingham, Alabama
^|| Cardiology Division, University of North Carolina, Chapel Hill, North Carolina
^¶ Statistics Department, Duke Clinical Research Institute, Durham, North Carolina
^# Cardiology Division, Duke University Medical Center, Duke Clinical Research Institute, Durham, North Carolina.

Manuscript received November 5, 2005; revised manuscript received January 24, 2006, accepted February 7, 2006.

^_* Reprint requests and correspondence: Dr. Javed Butler, Cardiovascular Medicine Division, 383-PRB, Vanderbilt University Medical Center, Nashville, Tennessee 37232. (Email: javed.butler{at}vanderbilt.edu).

OBJECTIVES: The purpose of this study was to determine the effect of beta-blocker therapy on outcomes of hospitalized heart failure (HF) patients enrolled in the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization (ESCAPE).

BACKGROUND: The effect of beta-blocker therapy on outcomes among hospitalized HF patients is not well documented.

METHODS: We studied the association between beta-blocker therapy and outcomes among 432 hospitalized HF patients in the ESCAPE trial.

RESULTS: A total of 268 patients (62%) were on beta-blockers before admission. These patients had a shorter length of stay (7.9 ± 6.3 days vs. 9.4 ± 6.7 days; p < 0.01) and a lower six-month mortality rate (16% vs. 24%; p = 0.03) compared with those who were not on beta-blockers. Of the patients who were on admission beta-blockers and were discharged alive (n = 263), beta-blockers were discontinued in 54 and significantly modified (>50% dose reduction or changed to alternative beta-blocker) in 28 patients during hospitalization. Factors associated with discontinuation of beta-blockers during hospitalization included respiratory rate >24 breaths/min (30.8% vs. 16.9%; p = 0.03), heart rate >100 beats/min (19.2% vs. 7.3%; p = 0.01), lower ejection fraction (17.9 ± 5.4% vs. 20.2 ± 7.1%; p = 0.04), diabetes (21.2% vs. 37.1%; p = 0.03), and systolic blood pressure <100 mm Hg during hospitalization (70.3% vs. 54.1%; p = 0.03). After adjusting for factors associated with beta-blocker use and those with outcomes, consistent beta-blocker use during hospitalization was associated with a significant reduction in the rate of rehospitalization or death within six months after discharge (odds ratio 0.27, 95% confidence interval 0.10 to 0.71; p < 0.01).

CONCLUSIONS: Beta-blocker therapy before and during hospitalization for HF is associated with improved outcomes.

Abbreviations and Acronyms   BUN = blood urea nitrogen   CI = confidence interval   EF = ejection fraction   ESCAPE = Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization   HF = heart failure   HR = hazard ratio   OR = odds ratio   PAC = pulmonary artery catheter   PCWP = pulmonary capillary wedge pressure

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