Beta‐blocker therapy in advanced heart failure: clinical characteristics and long‐term outcomes

Abstract

Aims: To evaluate the clinical characteristics and long-term outcomes of advanced heart failure patients (NYHA Class IIIb-IV) receiving beta-blocker therapy vs. those patients not receiving beta-blockers at randomization in the FIRST trial, a randomized, double-blind, placebo-controlled trial of epoprostenol vs. usual care in advanced heart failure. Methods and results: The patient population consisted of 471 patients enrolled in FIRST with Class IIIb-IV heart failure, left ventricular ejection fraction (LVEF) of < 30%, advanced hemodynamic abnormalities, and standard pharmacologic treatment of ACE-inhibitor, diuretics, and/or digoxin. The study cohort consisted of 448 patients not receiving beta-blockers and 23 patients receiving beta-blockers at randomization for the FIRST trial. Patients in the beta-blocker group had decreased rates of any clinical event (P = 0.03), worsening heart failure (P = 0.001), and death or worsening heart failure (P = 0.0008) than patients not receiving beta-blockers. After adjusting for prognostically important variables, the favorable effect of beta-blockers on worsening heart failure (P = 0.02) and death or worsening heart failure (P = 0.02) persisted. Conclusion: Patients with advanced heart failure who receive beta-blocker therapy have a lower rate of hospitalization and are less likely to experience worsening heart failure or death at 6 months than patients who are not treated with beta-blockers. These observational data contribute to the growing body of data demonstrating a favorable effect of beta-blockers on clinical outcomes in heart failure.

Beta-Blocker Use and Outcomes Among Hospitalized Heart Failure Patients

“…A secondary analysis of the Outcomes of a Prospective Trial of Intravenous Milrinone for Exacerbations of Chronic Heart Failure (OPTIME-CHF) study by Gattis et al (9) suggested that beta-blocker discontinuation during hospitalization was associated with a higher mortality rate after discharge within 60 days. Similarly, a retrospective analysis of the Flolan International Randomized Survival Trial (FIRST) database assessed clinical outcomes related to beta-blocker use at randomization and reported no excess risk for patients treated with beta-blockers at the time of hospital presentation (10). In this investigation, we assessed this issue using the ESCAPE trial database and found that continuation of beta-blocker therapy, even after adjusting for potential confounders associated with beta-blocker use or the outcomes studied, was associated with a lower mortality and rehospitalization rate subsequent to discharge.…”

Clinical profile and management of heart failure: rural community hospital vs. metropolitan heart center

“…The study results indicating favorable effects of heart failure therapy using β‐blockers in functional class IV were published very recently [30] while the favorable effects of β‐blockade in heart failure in general have been published in 1989 and thereafter [31]. However, the proportion of functional class IV with the rural hospital patient group was as high as 69%, which might at least partially explain the lower β‐blocker use in that particular patient group.…”

Clinical profile, contemporary management and one‐year mortality in patients with severe acute heart failure syndromes: The EFICA study☆

“…Unlike chronic heart failure (CHF), for which a wealth of information is available, specific epidemiological data on ADHF are currently lacking. Indeed, available data are non‐specific, and usually derived from hospital discharge records corresponding to the general heart failure code [ICM 184] [3–5] as well as from a limited number of recent large clinical trials in patients with worsening heart failure [6–9].…”