This article is more than 5 years old. Information may no longer be current.
OPTIMIZE-HF: Continuation of beta-blocker therapy reduced risk for post-discharge mortality, rehospitalization
Click Here to Manage Email Alerts
Continuation of beta-blocker therapy was associated with a reduced risk for post-discharge death and rehospitalization when compared with not receiving beta-blocker therapy, according to data from the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF).
However, beta-blocker therapy discontinuation was related to greater adjusted mortality risk post-discharge compared with the continuation of beta-blocker therapy.
Researchers from various U.S. sites examined the effect of withdrawing or continuing beta-blocker therapy in patients hospitalized for HF among patients in the registry study.
Of the 2,373 patients eligible for beta-blockers, 1,350 patients continued therapy after admission, 632 patients started therapy after admission, therapy was withdrawn in 79 patients, and 303 patients were eligible but were not treated with beta-blockers.
Continuing beta-blocker therapy was correlated with a propensity-adjusted lower risk of post-discharge death (HR: 0.60; 95% CI: 0.37-0.99), according to the study abstract. However, withdrawing therapy correlated with higher propensity-adjusted mortality and higher risk for mortality (HR: 2.3; 95%CI: 1.2-4.6).
“Our findings suggest that routine discontinuation of beta-blocker therapy on hospital admission is neither necessary nor advisable,” Gregg C. Fonarow, MD, professor of medicine at the David Geffen School of Medicine at UCLA and a study researcher, told Cardiology Today. “The single most important factor in determining whether a patient hospitalized with HF will survive the next 60 to 90 days is whether or not beta-blocker therapy is continued.”
J Am Coll Cardiol. 2008;52:190-199.
Fonarow and colleagues emphasize the importance of using beta-blocker therapy in patients with HF while they are hospitalized (ie, not just at the time of discharge). Many clinicians will either stop or empirically reduce the dose of beta-blockers when patients are admitted with acute decompensated HF, despite the recommendation by many experts to only stop beta-blocker therapy when the patient’s fluid overload is not responsive to diuretics and/or the patient’s hemodynamic status is compromised. These results suggest that withdrawing beta-blocker during an HF admission may be deleterious and should be avoided whenever clinically feasible.
– Douglas L. Mann, MD
Cardiology Today Editorial Board member
This is an important study because we now have good data to support the continuation of beta-blocker therapy both during and following an admission for acute decompensated HF. Data continue to support that standard treatment with ACE inhibitors, beta-blockers and aldosterone antagonists are essential to improving survival and reducing morbidity in patients with HF. As we continue to refine the old notions that beta-blockers are not indicated in the decompensated patient, we can expect to see an overall reduction in the burden of HF on our hospitals and health care system. Every practitioner who treats decompensated HF should take note of this study and work diligently to continue the drugs we know improve patients with this syndrome.
– Frank Smart, MD
Cardiology Today Editorial Board member