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J Am Coll Cardiol, 2008; 52:190-199, doi:10.1016/j.jacc.2008.03.048
© 2008 by the American College of Cardiology Foundation
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CLINICAL RESEARCH: HEART FAILURE

Influence of Beta-Blocker Continuation or Withdrawal on Outcomes in Patients Hospitalized With Heart Failure

Findings From the OPTIMIZE-HF Program

Gregg C. Fonarow, MD, FACC*,*, William T. Abraham, MD, FACP, FACC{dagger}, Nancy M. Albert, PhD, RN{ddagger}, Wendy Gattis Stough, PharmD§, Mihai Gheorghiade, MD||, Barry H. Greenberg, MD, FACC, Christopher M. O'Connor, MD, FACC#, Jie Lena Sun, MS**, Clyde W. Yancy, MD, FACC{dagger}{dagger}, James B. Young, MD, FACC{ddagger}{ddagger} on behalf of the OPTIMIZE-HF Investigators and Coordinators

* Department of Medicine, University of California–Los Angeles Medical Center, Los Angeles, California
{dagger} Division of Cardiology, The Ohio State University, Columbus, Ohio
{ddagger} George M. and Linda H. Kaufman Center for Heart Failure, Cleveland Clinic Foundation, Cleveland, Ohio
§ Department of Medicine, Duke University Medical Center, Durham, North Carolina, and Department of Clinical Research, Campbell University School of Pharmacy, Research Triangle Park, North Carolina
|| Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
Department of Medicine, USCD Medical Center, University of California, San Diego, California
# Division of Cardiology, Duke University Medical Center/Duke Clinical Research Institute, Durham, North Carolina
** Duke Clinical Research Institute, Durham, North Carolina
{dagger}{dagger} Baylor University Medical Center, Dallas, Texas
{ddagger}{ddagger} Department of Cardiovascular Medicine, Heart Failure Section, Cleveland Clinic Foundation, Cleveland, Ohio.

Manuscript received October 15, 2007; revised manuscript received March 10, 2008, accepted March 12, 2008.

* Reprint requests and correspondence: Dr. Gregg C. Fonarow, Ahmanson-UCLA Cardiomyopathy Center, UCLA Medical Center, 10833 LeConte Avenue, Room 47-123 CHS, Los Angeles, California 90095-1679. (Email: gfonarow{at}mednet.ucla.edu).

Objectives: This study ascertains the relationship between continuation or withdrawal of beta-blocker therapy and clinical outcomes in patients hospitalized with systolic heart failure (HF).

Background: Whether beta-blocker therapy should be continued or withdrawn during hospitalization for decompensated HF has not been well studied in a broad cohort of patients.

Methods: The OPTIMIZE-HF (Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure) program enrolled 5,791 patients admitted with HF in a registry with pre-specified 60- to 90-day follow-up at 91 academic and community hospitals throughout the U.S. Outcomes data were prospectively collected and analyzed according to whether beta-blocker therapy was continued, withdrawn, or not started.

Results: Among 2,373 patients eligible for beta-blockers at discharge, there were 1,350 (56.9%) who were receiving beta-blockers before admission and continued on therapy, 632 (26.6%) newly started, 79 (3.3%) in which therapy was withdrawn, and 303 (12.8%) eligible but not treated. Continuation of beta-blockers was associated with a significantly lower risk and propensity adjusted post-discharge death (hazard ratio [HR]: 0.60; 95% confidence interval [CI]: 0.37 to 0.99, p = 0.044) and death/rehospitalization (odds ratio: 0.69; 95% CI: 0.52 to 0.92, p = 0.012) compared with no beta-blocker. In contrast, withdrawal of beta-blocker was associated with a substantially higher adjusted risk for mortality compared with those continued on beta-blockers (HR: 2.3; 95% CI: 1.2 to 4.6, p = 0.013), but with similar risk as HF patients eligible but not treated with beta-blockers.

Conclusions: The continuation of beta-blocker therapy in patients hospitalized with decompensated HF is associated with lower post-discharge mortality risk and improved treatment rates. In contrast, withdrawal of beta-blocker therapy is associated with worse risk and propensity-adjusted mortality. (Organized Program To Initiate Lifesaving Treatment In Hospitalized Patients With Heart Failure [OPTIMIZE-HF]; NCT00344513 [ClinicalTrials.gov] )

Key Words: heart failure • beta-blockers • mortality • registry

Abbreviations and Acronyms
  CI = confidence interval
  HF = heart failure
  HR = hazard ratio
  LVEF = left ventricular ejection fraction
  LVSD = left ventricular systolic dysfunction
  OR = odds ratio


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J. Am. Coll. Cardiol. 2008 52: A24. [Full Text] [PDF]






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