Author + information
- Received October 15, 2007
- Revision received March 10, 2008
- Accepted March 12, 2008
- Published online July 15, 2008.
- Gregg C. Fonarow, MD, FACC⁎,⁎ (, )
- William T. Abraham, MD, FACP, FACC†,
- Nancy M. Albert, PhD, RN‡,
- Wendy Gattis Stough, PharmD§,
- Mihai Gheorghiade, MD∥,
- Barry H. Greenberg, MD, FACC¶,
- Christopher M. O'Connor, MD, FACC#,
- Jie Lena Sun, MS⁎⁎,
- Clyde W. Yancy, MD, FACC††,
- James B. Young, MD, FACC‡‡,
- OPTIMIZE-HF Investigators and Coordinators
- ↵⁎Reprint requests and correspondence:
Dr. Gregg C. Fonarow, Ahmanson-UCLA Cardiomyopathy Center, UCLA Medical Center, 10833 LeConte Avenue, Room 47-123 CHS, Los Angeles, California 90095-1679.
Objectives This study ascertains the relationship between continuation or withdrawal of beta-blocker therapy and clinical outcomes in patients hospitalized with systolic heart failure (HF).
Background Whether beta-blocker therapy should be continued or withdrawn during hospitalization for decompensated HF has not been well studied in a broad cohort of patients.
Methods The OPTIMIZE-HF (Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure) program enrolled 5,791 patients admitted with HF in a registry with pre-specified 60- to 90-day follow-up at 91 academic and community hospitals throughout the U.S. Outcomes data were prospectively collected and analyzed according to whether beta-blocker therapy was continued, withdrawn, or not started.
Results Among 2,373 patients eligible for beta-blockers at discharge, there were 1,350 (56.9%) who were receiving beta-blockers before admission and continued on therapy, 632 (26.6%) newly started, 79 (3.3%) in which therapy was withdrawn, and 303 (12.8%) eligible but not treated. Continuation of beta-blockers was associated with a significantly lower risk and propensity adjusted post-discharge death (hazard ratio [HR]: 0.60; 95% confidence interval [CI]: 0.37 to 0.99, p = 0.044) and death/rehospitalization (odds ratio: 0.69; 95% CI: 0.52 to 0.92, p = 0.012) compared with no beta-blocker. In contrast, withdrawal of beta-blocker was associated with a substantially higher adjusted risk for mortality compared with those continued on beta-blockers (HR: 2.3; 95% CI: 1.2 to 4.6, p = 0.013), but with similar risk as HF patients eligible but not treated with beta-blockers.
Conclusions The continuation of beta-blocker therapy in patients hospitalized with decompensated HF is associated with lower post-discharge mortality risk and improved treatment rates. In contrast, withdrawal of beta-blocker therapy is associated with worse risk and propensity-adjusted mortality. (Organized Program To Initiate Lifesaving Treatment In Hospitalized Patients With Heart Failure [OPTIMIZE-HF]; NCT00344513)
For full author disclosures, please see the end of this article.
The OPTIMIZE-HF program and this study were funded by GlaxoSmithKline, Philadelphia, Pennsylvania.
Alfred A. Bove, MD, served as Guest Editor for this article.
- Received October 15, 2007.
- Revision received March 10, 2008.
- Accepted March 12, 2008.
- American College of Cardiology Foundation