J Korean Med Sci.  2020 Aug;35(33):e278. 10.3346/jkms.2020.35.e278.

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

• Ahn MS
• Yoo BS
• Son JW
• Yu MH
• Kang DR
• Lee HY
• Jeon ES
• Kim JJ
• Chae SC
• Baek SH
• Kang SM
• Choi DJ
• Kim KH
• Cho MC
• Kim SY

• KMID: 2505594
• DOI: http://doi.org/10.3346/jkms.2020.35.e278

Abstract

Background
β-blockers (BBs) are considered primary therapy in stable heart failure (HF) with reduced ejection fraction (HFrEF) without atrial fibrillation (AF); evidence-based benefits of BB on outcome have been documented. However, BBs have not been shown to improve mortality or reduce hospital admissions in HF patients with AF. This study assessed the relationship between BBs at discharge and relevant clinical outcomes in acute heart failure (AHF) patients with AF.
Methods
From the Korean Acute Heart Failure Registry, 936 HFrEF and 639 HF patients with preserved ejection fraction (HFpEF) and AF were selected. Propensity score (PS) matching accounted for BB selection bias when assessing associations.
Results
BB-untreated patients in the overall cohort of HFrEF and HFpEF had greater deteriorated clinical and laboratory characteristics. In the 670 PS-matched cohort of HFrEF patients, incidences of all clinical events at 60 days and 1 year were not different according to use of BBs. In the 470 PS-matched cohort of HFpEF, rehospitalization and composite outcome at 6 months and 1 year more frequently occurred in non-users of BBs. After adjusting for covariates in the multivariable Cox model of matched cohorts, BB was not associated with clinical outcomes at 60 days and 1 year in HFrEF with AF patients. In HFpEF patients with AF, BB use was associated with reduced 6-month (hazard ratio [HR], 0.38; 95% confidence interval [CI], 0.20–0.74) and 1-year rehospitalization (HR, 0.53; 95% CI, 0.34–0.82).
Conclusion
In the HFrEF with AF PS-matched cohort, the use of BBs at discharge was not associated with clinical outcome. However, in HFpEF with AF, the use of BB was associated with reduced rehospitalization during the 6-month and 1-year follow up.

Keyword

Heart Failure; Atrial Fibrillation; β-blocker

Figure

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  Fig. 1 Sixty-day and 1-year event-free survival according to treatment with β-blockers in heart failure with reduced ejection fraction. (A) Heart failure hospitalization, (B) mortality, (C) composite endpoint at 60-day and (D-F) at 1 year (β-blocker treated, dotted line: β-blocker untreated).

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  Fig. 2 Forest plot of clinical outcomes of the β-blocker-treated group compared to those of the untreated group.HR = hazard ratio, CI = confidence interval, HFrEF = heart failure with reduced ejection fraction, AF = atrial fibrillation.

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  Fig. 3 Sixty-day and 1-year event-free survival according to the treatment of β-blocker in heart failure with preserved ejection fraction. (A) heart failure hospitalization, (B) mortality, (C) composite endpoint at 60-day and (D-F) at 1 year (β-blocker treated, dotted line: β-blocker untreated).

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