Beneficial association of β-blocker therapy on recovery from severe acute heart failure treatment: data from the Survival of Patients With Acute Heart Failure in Need of Intravenous Inotropic Support trial.

Abstract

Beta-blocker therapy is recommended for most patients with chronic heart failure, although such therapy may be discontinued or reduced during hospitalizations. The aim is to determine whether β-blocker use at study entry and/or at discharge has an impact on 31- and 180-day survival. Survival of Patients With Acute Heart Failure in Need of Intravenous Inotropic Support study was designed as a randomized, double-blind, active-controlled, multi-center study. Multinational. A total of 1,327 critically ill patients hospitalized with low-output heart failure in need of inotropic therapy. Levosimendan versus dobutamine. All-cause mortality at 31 and 180 days in patients who survived initial hospitalization with/without β-blocker use at entry and/or at discharge. Patients on β-blockers at entry and at discharge had significantly lower 31-day (p < .0001) and 180-day (p < .0001) mortality compared to patients without β-blockers use at both time points. The association was robust when adjusted for age and co-morbidities (p = .006 at 31 days; p = .003 at 180 days). Those results strongly suggest, in severe acutely decompensated heart failure patients, admitted on β-blockers, to continue on them at discharge.