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Beta-blocker Therapy at Discharge in Patients with Acute Heart Failure and Atrial Fibrillation

Min Soo Ahn1, Byung Su Yoo2, Jung Woo Son1

  • 1Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.

Journal of Korean Medical Science
|August 25, 2020
PubMed

Insights

Beta-blockers (BBs) did not improve outcomes in heart failure with reduced ejection fraction (HFrEF) patients who also have atrial fibrillation (AF). However, BBs were associated with reduced rehospitalization in heart failure with preserved ejection fraction (HFpEF) patients with AF.

Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • Beta-blockers (BBs) are standard therapy for stable heart failure with reduced ejection fraction (HFrEF) without atrial fibrillation (AF).
  • Evidence for BBs improving mortality or reducing hospital admissions in heart failure (HF) patients with AF is lacking.
  • This study investigated the impact of BBs at discharge on clinical outcomes in acute heart failure (AHF) patients with AF.

Purpose of the Study:

  • To assess the association between beta-blocker (BB) use at discharge and clinical outcomes in patients with acute heart failure (AHF) and atrial fibrillation (AF).
  • To compare outcomes in HFrEF and HFpEF patients with AF treated with BBs versus those not treated.

Main Methods:

  • Analysis of 936 HFrEF and 639 HFpEF patients with AF from the Korean Acute Heart Failure Registry.
  • Propensity score (PS) matching was employed to mitigate selection bias in BB use.
  • Outcomes were assessed at 60 days, 6 months, and 1 year post-discharge.

Main Results:

  • In PS-matched HFrEF patients with AF, BB use was not associated with differences in clinical events at 60 days or 1 year.
  • In PS-matched HFpEF patients with AF, non-users of BBs experienced more frequent rehospitalization and composite outcomes at 6 months and 1 year.
  • Multivariable Cox modeling confirmed no association between BBs and outcomes in HFrEF with AF, but showed reduced 6-month and 1-year rehospitalization in HFpEF with AF patients on BBs.

Conclusions:

  • Beta-blocker use at discharge was not linked to improved clinical outcomes in patients with HFrEF and AF.
  • In contrast, beta-blocker therapy was associated with significantly reduced rehospitalization rates in patients with HFpEF and AF at both 6-month and 1-year follow-ups.
Abstract

Keywords:
Atrial FibrillationHeart Failureβ-blocker

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