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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, Nancy M. Albert, PhD, RN, 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, James B. Young, MD, FACC on behalf of the OPTIMIZE-HF Investigators and Coordinators

^_* Department of Medicine, University of California–Los Angeles Medical Center, Los Angeles, California
Division of Cardiology, The Ohio State University, Columbus, Ohio
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
Baylor University Medical Center, Dallas, Texas
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Background: Whether beta-blocker therapy should be continued or withdrawn during hospitalization for decompensated HF has not been well studied in a broad cohort of patients.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]