Lower In‐Hospital Mortality With Beta‐Blocker Use at Admission in Patients With Acute Decompensated Heart Failure

Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease

卷:10

Kazuya Nagao¹  Yukihito Sato²  Mamoru Toyofuku³  Takashi Morinaga⁴  Hidenori Yaku⁵  Moritake Iguchi⁶  Mitsunori Kawato⁷  Ryusuke Nishikawa⁸  Toshihiro Tamura⁹  Makoto Miyake⁹  Yodo Tamaki⁹  Hirokazu Kondo⁹  Takeshi Kitai¹⁰  Yuichi Kawase¹¹  Yusuke Yoshikawa¹²  Neiko Ozasa¹²  Erika Yamamoto¹²  Takeshi Kimura¹²  Takao Kato¹²  Yasutaka Inuzuka¹³  Koichiro Kuwahara¹⁴  Takeshi Morimoto¹⁵  Yoshihisa Nakagawa¹⁶ 

[1] Cardiovascular Center Osaka Red Cross Hospital Osaka Japan;

[2] Department of Cardiology Hyogo Prefectural Amagasaki General Medical Center Hyogo Japan;

[3] Department of Cardiology Japanese Red Cross Wakayama Medical Center Wakayama Japan;

[4] Department of Cardiology Kokura Memorial Hospital Fukuoka Japan;

[5] Department of Cardiology Mitsubishi Kyoto Hospital Kyoto Japan;

[6] Department of Cardiology National Hospital Organization Kyoto Medical Center Kyoto Japan;

[7] Department of Cardiology Nishikobe Medical Center Hyogo Japan;

[8] Department of Cardiology Shizuoka General Hospital Shizuoka Japan;

[9] Department of Cardiology Tenri Hospital Nara Japan;

[10] Department of Cardiovascular Medicine Kobe City Medical Center General Hospital Hyogo Japan;

[11] Department of Cardiovascular Medicine Kurashiki Central Hospital Okayama Japan;

[12] Department of Cardiovascular Medicine Kyoto University Graduate School of Medicine Kyoto Japan;

[13] Department of Cardiovascular Medicine Shiga General Hospital Shiga Japan;

[14] Department of Cardiovascular Medicine Shinshu University Nagano Japan;

[15] Department of Clinical Epidemiology Hyogo College of Medicine Hyogo Japan;

[16] Division of Cardiovascular Medicine Shiga University of Medical Science Shiga Japan;

关键词: acute decompensated heart failure;    beta‐blocker;    cohort study;   

DOI  :  10.1161/JAHA.120.020012

来源: DOAJ

【 摘 要 】

Background It remains unclear whether beta‐blocker use at hospital admission is associated with better in‐hospital outcomes in patients with acute decompensated heart failure. Methods and Results We evaluated the factors independently associated with beta‐blocker use at admission, and the effect of beta‐blocker use at admission on in‐hospital mortality in 3817 patients with acute decompensated heart failure enrolled in the Kyoto Congestive Heart Failure registry. There were 1512 patients (39.7%) receiving, and 2305 patients (60.3%) not receiving beta‐blockers at admission for the index acute decompensated heart failure hospitalization. Factors independently associated with beta‐blocker use at admission were previous heart failure hospitalization, history of myocardial infarction, atrial fibrillation, cardiomyopathy, and estimated glomerular filtration rate <30 mL/min per 1.73 m2. Factors independently associated with no beta‐blocker use were asthma, chronic obstructive pulmonary disease, lower body mass index, dementia, older age, and left ventricular ejection fraction <40%. Patients on beta‐blockers had significantly lower in‐hospital mortality rates (4.4% versus 7.6%, P<0.001). Even after adjusting for confounders, beta‐blocker use at admission remained significantly associated with lower in‐hospital mortality risk (odds ratio, 0.41; 95% CI, 0.27–0.60, P<0.001). Furthermore, beta‐blocker use at admission was significantly associated with both lower cardiovascular mortality risk and lower noncardiovascular mortality risk. The association of beta‐blocker use with lower in‐hospital mortality risk was relatively more prominent in patients receiving high dose beta‐blockers. The magnitude of the effect of beta‐blocker use was greater in patients with previous heart failure hospitalization than in patients without (P for interaction 0.04). Conclusions Beta‐blocker use at admission was associated with lower in‐hospital mortality in patients with acute decompensated heart failure. Registration URL: https://www.upload.umin.ac.jp/; Unique identifier: UMIN000015238.

【 授权许可】

Unknown