B-CONVINCED: Beta-blocker CONtinuation Vs. INterruption in patients with Congestive heart failure hospitalizED for a...

Area of Science:

• Cardiology
• Pharmacology

Background:

• Acutely decompensated heart failure (ADHF) management often involves uncertainty regarding the continuation of beta-blocker therapy.
• Beta-blockers are crucial for long-term heart failure management, but their role during acute decompensation requires clarification.

Purpose of the Study:

• To determine if continuing beta-blocker therapy during ADHF impacts patient recovery.
• To assess the non-inferiority of beta-blocker continuation versus discontinuation in patients with reduced ejection fraction.

Main Methods:

• A randomized, controlled, open-label, non-inferiority trial was conducted.
• 169 patients with LVEF < 40% on stable beta-blocker therapy were randomized to continue or discontinue therapy during ADHF.
• Primary endpoint was physician-assessed improvement in dyspnea and well-being at 3 days.

Main Results:

• Continuation of beta-blockers was non-inferior to discontinuation, with 92.8% vs. 92.3% improvement at 3 days.
• No significant differences were observed in recovery at 8 days, plasma BNP, hospital stay, or 3-month mortality.
• A significantly higher rate of chronic beta-blocker prescription was observed at 3 months in the continuation group (90% vs. 76%).

Conclusions:

• Continuing beta-blocker therapy during ADHF does not delay or impair acute recovery.
• Beta-blocker continuation is associated with improved long-term adherence to established beneficial therapy.
• The findings support the continuation of beta-blockers in ADHF patients with reduced ejection fraction previously on stable therapy.