Beta-blocker use after hospital discharge appears beneficial in severe acute heart failure

Patients with severe acute heart failure appear to benefit from beta-blocker therapy after hospital discharge, a new study reports.

Researchers performed a post hoc analysis of data from the SURVIVE trial to determine whether maintaining or starting beta-blocker therapy during hospitalization for severe acute heart failure would affect long- or short-term survival after discharge. Patients in the SURVIVE trial all had severe heart failure, defined as inadequate response to intravenous diuretic or vasodilators and at least one of the following characteristics: oliguria not related to hypovolemia, dyspnea at rest or need for mechanical ventilation, or hemodynamic impairment with pulmonary artery catheter use plus requirement for intravenous inotropic support. Outcome measures were all-cause mortality 31 and 180 days after discharge with or without beta-blocker use at study entry and/or at discharge. The study results were published in the May Critical Care Medicine.

A total of 1,104 patients survived to hospital discharge and had data available on beta-blocker use. The 549 patients who were taking beta-blockers at study entry and at discharge had statistically significantly lower mortality rates at 31 days and 180 days (P<0.001 for both) than the 259 patients who were not taking beta-blockers at either time point. When the association was adjusted for age and comorbid conditions, the P values were 0.006 at 30 days and 0.003 at 180 days. In unadjusted analyses but not in adjusted analyses, the 40 patients who were taking beta-blockers at study entry but not at discharge had a higher mortality risk than those taking beta-blockers at both time points. The 259 patients who were not taking beta-blockers at either time point and patients taking beta-blockers only at study entry had a similar mortality risk.

The authors noted that the study was retrospective and that data on beta-blocker use did not include information on aspects such as dose, among other limitations. Prospective trials are needed, they said, to determine whether and how the discharge dose of beta-blockers affects outcomes and whether any beta-blocker is superior to others. However, they concluded that beta-blocker therapy at hospital admission and discharge improves both long- and short-term outcomes in patients with severe acute heart failure, and that withdrawing such therapy at hospital admission has a detrimental effect. The author of an accompanying editorial agreed, writing, “There is solid support for prescribing b-blockers, titrating to maximal tolerated doses, and continuing therapy even during acute exacerbations in patients with heart failure.”