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Poorer Clinical Outcomes and Longer Hospitalization with Beta Blocker Discontinuation in Acute Decompensated Heart
Mochamad Yusuf Alsagaff1, Dian Afrilla2, Desi Jannati2
1Universitas Airlangga, Dr. Soetomo General Hospital, Surabaya, Indonesia.
Background:
According to clinical guidelines, individuals with acute decompensated heart failure (ADHF) wet and warm without contraindications should continue and optimize their beta-blocker (BB) therapy. However, its implementation in clinical practice remains inconsistent, and clinicians still frequently discontinue BB therapy. The discontinuation is defined as the absence of BB therapy for at least 24 hours following hospital admission.
Aim:
The purpose of this study was to examine how clinical outcomes and length of stay are affected when BB therapy is discontinued in ADHF wet and warm patients without contraindication.
Methods:
Patients with ADHF from two hospitals participated in this retrospective observational cohort research. The inclusion criteria were aged ≥18 years, having received chronic beta-blocker therapy before hospitalization, and having a Left Ventricular Ejection Fraction (LVEF) of ≤40%. The study excluded patients with incomplete data and those who were contraindicated for beta-blocker medication. The data obtained were analyzed using descriptive and statistical analyses.
Results:
The inclusion criteria resulted in 243 patients: 168 (69.1%) men and 75 (30.9%) women. On average, the age range was 56.2 ± 12.9 years, with mean ages of 54.8 ± 12.1 years in the beta-blocker continuation group and 57.1 ± 13.4 years in the discontinuation group. From the total, 60.1% discontinued the BB therapy, and 39.9% continued receiving it during their hospitalization. The results show that patients who stopped taking BBs experienced a noticeably greater rate of heart failure deterioration than those who continued taking them (10.3% vs 2.1%, P = 0.027). Patients receiving BBs had significantly lower in-hospital mortality rates, as well as both cardiovascular mortality (8.2% vs 1.0%, P = 0.04) and all-cause mortality (10.3% vs 1.0%, P = 0.021). Furthermore, patients who discontinued BB therapy experienced a longer hospitalization (6.5 ± 3.5 vs 5.8 ± 3.5 days, P = 0.023).
Conclusion:
In the case of ADHF, beta-blocker discontinuation is linked to poorer clinical outcomes.
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