Abstract 11065: Continuation versus Discontinuation of Beta Blockers in Patients Admitted with Acute Decompensated Heart Failure Requiring Inotropes

Abstract

Introduction: Heart failure is one of the leading causes of morbidity and mortality globally. The use of beta blockers (BB) in patients with chronic heart failure is the cornerstone of guideline directed medical therapy and is recommended by national guidelines. However, BB are often discontinued when a patient is admitted to the hospital with ADHF, especially when inotropic support is needed. Little is known about the effects of continuing BB therapy in patients with ADHF requiring inotropes. This study sought to compare the effect of BB continuation vs discontinuation on in-hospital mortality among patients admitted to the hospital in ADHF requiring inotropic therapy. Methods: A single center, retrospective, non-blinded study was conducted in patients hospitalized with ADHF requiring inotropes over a three-year period. Inclusion criteria were patients ≥ 18 years of age admitted with ADHF and treated with inotropes (milrinone, dobutamine) from 1/1/2017-1/1/2020 at Wake Forest Baptist Medical Center. We assessed BB continuation and discontinuation on admission. Continuation of BB was defined as BB given at least 50% of patient’s hospitalization time. A time to event analysis framework was implemented using Cox proportional hazards models to analyze the effect of BB use on in-hospital mortality. Results: A total of 449 patients were admitted with ADHF requiring inotropes who met study criteria. Of those patients, 206 (45.9%) were admitted and continued on BB therapy. Continuation of BB therapy was associated with significant improvements in survival compared with patients whose BB was discontinued. Compared with the BB discontinuation group, a 70% reduction in the likelihood of in-hospital mortality was observed among individuals that continued BB therapy [HR 0.30, 95% Cl: 0.18-0.61, p<0.002]. Conclusion: In our study, among patients admitted with ADHF requiring inotropes, those continued on BB therapy were 70% less likely to die during their hospitalization.