Continuing Vs. Withholding Home Beta-Blockers at Admission for Suspected Infection: A Target Trial Emulation.
Nathaniel Christian-Miller1, Kathleen Tiffany Lee2, Raymond Pashun3
1Department of Internal Medicine, University of Michigan, Ann Arbor, MI.
Critical Care Medicine
|June 9, 2026
Summary
Continuing beta-blockers for patients admitted with suspected infection reduced 90-day mortality and hospital stay. This finding supports further research into beta-blocker use in sepsis care.
Area of Science:
- Cardiology
- Critical Care Medicine
- Pharmacology
Background:
- Beta-blockers are standard for chronic cardiovascular conditions.
- These medications are often discontinued for patients with suspected sepsis due to concerns about hemodynamic compromise.
- Evidence is lacking on the impact of continuing beta-blockers in this patient population.
Purpose of the Study:
- To compare 90-day all-cause mortality between patients who continued versus discontinued beta-blockers upon hospital admission for suspected infection.
- To investigate the association between beta-blocker continuation and clinical outcomes in patients with suspected infection.
Main Methods:
- Retrospective cohort study utilizing the target trial emulation framework.
- Cox regression with inverse probability of treatment weighting was employed to analyze data from a large academic tertiary care center.
- Included patients aged 18+ on beta-blockers admitted for suspected infection, excluding those in shock or with specific heart rate criteria.
Main Results:
- Continuation of oral beta-blockers was associated with a significantly reduced risk of 90-day all-cause mortality (HR 0.77; 95% CI, 0.61-0.98).
- Patients continuing beta-blockers experienced a shorter hospital stay (IRR 0.39; 95% CI, 0.38-0.41).
- No significant association was found between beta-blocker continuation and in-hospital mortality (OR 0.60; 95% CI, 0.30-1.20).
Conclusions:
- Continuing chronic beta-blockers in patients admitted with suspected infection is linked to better clinical outcomes.
- These findings highlight the potential benefit of maintaining beta-blocker therapy in patients with possible sepsis.
- Further controlled studies are warranted to confirm the role of beta-blocker continuation in sepsis management.
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