Skip to main content

Advertisement

SpringerLink
Log in

BETAWIN-AHF study: effect of beta-blocker withdrawal during acute decompensation in patients with chronic heart failure

  • Original Paper
  • Published:
Clinical Research in Cardiology Aims and scope Submit manuscript

Abstract

Objective

To evaluate the effects of discontinuing chronic beta-blocker (BB) treatment on short-term outcome in patients with chronic heart failure (CHF) during acute decompensation.

Methods

We selected all the patients previously diagnosed with CHF and currently on BB and attended for acute heart failure (AHF) in one of the 35 Spanish emergency departments participating in the EAHFE registry. Patients were classified according to BB maintenance or withdrawal (BBM or BBW, respectively) during the episode. In-hospital mortality was the primary endpoint; and 30-day mortality, 30-day combined endpoint, and prolonged hospitalization were secondary. We used logistic regression for adjustment of results according to the differences between the BBM and BBW groups, and stratified analysis by age, sex, left ventricular ejection fraction, chronic obstructive pulmonary disease, heart rate (HR), and BB type (carvedilol/bisoprolol) was performed.

Results

Among 2058 patients receiving chronic BB treatment, 1990 were analyzed: BBM 530 (27 %), BBW 1460 (73 %). Compared to BBM, BBW had a higher in-hospital mortality (5.5 vs 3.0 %; p < 0.05), 30-day mortality (8.7 vs 4.5 %; p < 0.01), and 30-day combined endpoint (29.8 vs 23.4 %; p < 0.05). Multivariate adjustment confirmed an independent direct association between BBW and in-hospital mortality (OR 1.89; 95 % CI 1.09–3.26) and 30-day mortality (OR 2.01; 95 % CI 1.28–3.15). Stratified analysis indicated no interaction by all the subgroups analyzed, except for HR (p = 0.01 for interaction), which showed a greater negative impact of BBW in patients with HR >80 bpm (OR 2.74; 95 % CI 1.13–6.63).

Conclusions

In the absence of clear contraindications, BB treatment should be maintained during AHF episodes in patients already receiving BB at home.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Ohlmeier C, Mikolajczyk R, Frick J, Prütz F, Haverkamp W, Garbe E (2015) Incidence, prevalence and 1-year all-cause mortality of heart failure in Germany: a study based on electronic healthcare data of more than six million persons. Clin Res Cardiol 104:688–696

    Article  PubMed  Google Scholar 

  2. Adams KF Jr, Fonarow GC, Emerman CL et al (2005) Characteristics and outcomes of patients hospitalized for heart failure in the United States: rationale, design, and preliminary observations from the first 100,000 cases in the Acute Decompensated Heart Failure National Registry (ADHERE). Am Heart J 149:209–216

    Article  PubMed  Google Scholar 

  3. Cleland JG, Swedberg K, Follath F et al (2003) The EuroHeart Failure survey programme—a survey on the quality of care among patients with heart failure in Europe. Part 1: patient characteristics and diagnosis. Eur Heart J 24:442–463

    Article  CAS  PubMed  Google Scholar 

  4. Weintraub NL, Collins SP, Pang PS, American Heart Association Council on Clinical Cardiology and Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation et al (2010) Acute heart failure syndromes: emergency department presentation, treatment, and disposition: current approaches and future aims: a scientific statement from the American Heart Association. Circulation 122:1975–1996

    Article  PubMed  Google Scholar 

  5. Llorens P, Manito Lorite N, Manzano Espinosa L et al (2015) Consensus on improving the care integrated of patients with acute heart failure. Emergencias 27:245–266

    Google Scholar 

  6. Llorens P, Escoda R, Miró O et al (2015) Characteristics and clinical course of patients with acute heart failure and the therapeutic measures applied in Spanish emergency departments: based on the EAHFE registry (Epidemiology of Acute Heart Failure in Emergency Departments). Emergencias 27:11–22

    Google Scholar 

  7. (1999) Effect of metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL Randomised Intervention Trial in Congestive Heart Failure (MERIT-HF). Lancet 353:2001–2007

  8. (1999) The Cardiac Insufficiency Bisoprolol Study II (CIBIS-II): a randomised trial. Lancet 353:9–13

  9. Packer M, Coats AJ, Fowler MB et al (2001) Effect of carvedilol on survival in severe chronic heart failure. N Engl J Med 344:1651–1658

    Article  CAS  PubMed  Google Scholar 

  10. McMurray JJ, Adamopoulos S, Anker SD, Auricchio A, Böhm M, Dickstein K et al (2012) ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J 33:1787–1847

    Article  PubMed  Google Scholar 

  11. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, Drazner MH et al (2013) 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 62:e147–e239

    Article  PubMed  Google Scholar 

  12. Bueno H (2015) Acute heart failure in Spain: certainties and uncertainties. Emergencias 27:7–9

    Google Scholar 

  13. Jondeau G, Milleron O (2015) Beta-blockers in acute heart failure. JACC Heart Fail 3:654–656

    Article  PubMed  Google Scholar 

  14. Mueller C, Christ M, Cowie M et al (2015) European Society of Cardiology-Acute Cardiovascular Care Association Position paper on acute heart failure: a call for interdisciplinary care. Eur Heart J Acute Cardiovasc Care. doi:10.1177/2048872615593279

    Google Scholar 

  15. Bueno H (2015) Cardiovascular research continuity: a call to increase collaboration between cardiology and emergency care research. Emergencias 27:396–398

    Google Scholar 

  16. Prins KW, Neill JM, Tyler JO, Eckman PM, Duval S (2015) Effects of beta-blocker withdrawal in acute decompensated heart failure: a systematic review and meta-analysis. JACC Heart Fail 3:647–653

    Article  PubMed  PubMed Central  Google Scholar 

  17. Orso F, Baldasseroni S, Fabbri G, Gonzini L, Lucci D, D’Ambrosi C et al (2009) Role of beta-blockers in patients admitted for worsening heart failure in a real world setting: data from the Italian survey on acute heart failure. Eur J Heart Fail 11:77–84

    Article  CAS  PubMed  Google Scholar 

  18. Bohm M, Link A, Cai D, Nieminen MS, Filippatos GS, Salem R et al (2011) Beneficial association of beta-blocker therapy on recovery from severe acute heart failure treatment: data from the survival of patients with acute heart failure in need of intravenous inotropic support trial. Crit Care Med 39:940–944

    Article  PubMed  Google Scholar 

  19. Butler J, Young JB, Abraham WT, Bourge RC, Adams KF Jr, Clare R et al (2006) Beta-blocker use and outcomes among hospitalized heart failure patients. J Am Coll Cardiol 47:2462–2469

    Article  CAS  PubMed  Google Scholar 

  20. Fonarow GC, Abraham WT, Albert NM, Stough WG, Gheorghiade M, Greenberg BH et al (2008) Influence of beta-blocker continuation or withdrawal on outcomes in patients hospitalized with heart failure: findings from the OPTIMIZE-HF program. J Am Coll Cardiol 52:190–199

    Article  CAS  PubMed  Google Scholar 

  21. Gattis WA, O’Connor CM, Leimberger JD, Felker GM, Adams KF, Gheorghiade M (2003) Clinical outcomes in patients on beta-blocker therapy admitted with worsening chronic heart failure. Am J Cardiol 91:169–174

    Article  CAS  PubMed  Google Scholar 

  22. Jondeau G, Neuder Y, Eicher JC, Jourdain P, Fauveau E, Galinier M et al (2009) B-CONVINCED: beta-blocker CONtinuation vs. INterruption in patients with congestive heart failure hospitalized for a decompensation episode. Eur Heart J 30:2186–2192

    Article  CAS  PubMed  Google Scholar 

  23. Miró O, Escoda R, Martín-Sánchez FJ, Herrero P, Jacob J, Alquézar A et al (2015) Acute heart failure patient perceived quality with respect to the health care provided at the emergency department: CALPERICA Study. Emergencias 7:161–168

    Google Scholar 

  24. Miró O, Gil V, Müller C, Mebazaa A, Bueno H, Martín-Sánchez FJ et al (2015) How does a clinical trial fit into the real world? The RELAX-AHF study population into the EAHFE registry. Clin Res Cardiol 104:850–860

    Article  PubMed  Google Scholar 

  25. Ho KKL, Anderson KM, Kannel WB, Grosssman W, Levy D (1993) Survival after the onset of congestive heart failure in Framingham heart study subjects. Circulation 88:107–115

    Article  CAS  PubMed  Google Scholar 

  26. Abraham WT, Fonarow GC, Albert NM, Stough WG, Gheorghiade M, Greenberg BH et al (2008) Predictors of in-hospital mortality in patients hospitalized for heart failure: insights from the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF). J Am Coll Cardiol 52:347–356

    Article  PubMed  Google Scholar 

  27. Chioncel O, Vinereanu D, Datcu M, Ionescu DD, Capalneanu R, Brukner I et al (2011) The Romanian Acute Heart Failure Syndromes (ROAHFS) registry. Am Heart J 162:142–153

    Article  PubMed  Google Scholar 

  28. Nieminen MS, Brutsaert D, Dickstein K, Drexler H, Follath F, Harjola VP, Hochadel M, EuroHeart Survey Investigators, Heart Failure Association, European Society of Cardiology et al (2006) EuroHeart Failure Survey II (EHFS II): a survey on hospitalized acute heart failure patients: description of population. Eur Heart J 27:2725–2736

    Article  PubMed  Google Scholar 

  29. Hirt MN, Muttardi A, Helms TM, van den Bussche H, Eschenhagen T (2015) General practitioners’ adherence to chronic heart failure guidelines regarding medication: the GP-HF study. Clin Res Cardiol (Epub ahead of print) (PubMed PMID: 26552905)

  30. Salpeter S, Ormiston T, Salpeter E (2005) Cardioselective beta-blockers for chronic obstructive pulmonary disease. Cochrane Database Syst Rev:CD003566

  31. Lonn EM, Rambihar S, Gao P, Custodis FF, Sliwa K, Teo KK et al (2014) Heart rate is associated with increased risk of major cardiovascular events, cardiovascular and all-cause death in patients with stable chronic cardiovascular disease: an analysis of ONTARGET/TRANSCEND. Clin Res Cardiol 103:149–159

    Article  PubMed  Google Scholar 

  32. Li SJ, Sartipy U, Lund LH, Dahlström U, Adiels M, Petzold M et al (2015) Prognostic significance of resting heart rate and use of β-blockers in atrial fibrillation and sinus rhythm in patients with heart failure and reduced ejection fraction: findings from the Swedish Heart Failure Registry. Circ Heart Fail 8:871–879

    Article  CAS  PubMed  Google Scholar 

  33. Kotecha D, Holmes J, Krum H, Altman DG, Manzano L, Cleland JG et al (2014) Efficacy of β blockers in patients with heart failure plus atrial fibrillation: an individual-patient data meta-analysis. Lancet 384:2235–2243

    Article  CAS  PubMed  Google Scholar 

  34. de Groote P, Isnard R, Assyag P et al (2007) Is the gap between guidelines and clinical practice in heart failure treatment being filled? Insights from the IMPACT RECO survey. Eur J Heart Fail 9:1205–1211

    Article  PubMed  Google Scholar 

  35. Antonini P, Magrini L, Murphy M, Di Somma S (2015) Multidisciplinary participation for research in the emergency setting. Emergencias 27:399–402

    Google Scholar 

  36. Cohen Solal A, Leurs I, Assyag P et al (2012) Optimization of heart failure medical treatment after hospital discharge according to left ventricular ejection fraction: the FUTURE survey. Arch Cardiovasc Dis 05:355–365

    Article  Google Scholar 

Download references

Acknowledgments

This study was partially supported by grants from the Instituto de Salud Carlos III supported with funds from Spanish Ministry of Health, and FEDER (PI10/01918, PI11/01021, PI15/01019 and PI15/00773) and La Marató de TV3 (2015). Emergencies: processes and pathologies research group of the IDIBAPS receives financial support from the Catalonia Govern for Consolidated Groups of Investigation (GRC 2009/1385 and 2014/0313).

Francisco Javier Martín-Sánchez, Esther Rodríguez Adrada Mercedes Casanova Lage (Hospital Clínico San Carlos, Madrid). Òscar Miró, Víctor Gil, Rosa Escoda, Emmanuel Coloma (Hospital Clínic de Barcelona), María José Pérez-Durá, Eva Salvo (Hospital La Fe de Valencia). José Pavón, Ana Bella Álvarez (Hospital Dr. Negrín de Las Palmas de Gran Canaria). Antonio Noval (Hospital Insular de Las Palmas de Gran Canaria). José M. Torres (Hospital Reina Sofía de Córdoba). María Luisa López-Grima, Amparo Valero, María Ángeles Juan-Gómez (Hospital Dr. Peset de Valencia). Alfons Aguirre, Maria Àngels Pedragosa (Hospital del Mar de Barcelona). María Isabel Alonso, Francisco Ruiz (Hospital de Valme de Sevilla). José Miguel Franco (Hospital Miguel Servet de Zaragoza). Sergio Pardo (Hospital San Juan de Alicante). Ana Belen Mecina, Rocio Merino Genicio (Hospital de Alcorcón). Josep Tost, Belen de la Fuente Penco, Antònia López Sánchez (Consorci Sanitari de Terrassa). Jordi Fabregat (Hospital Mutua de Terrasa). Susana Sánchez (Hospital Rio Ortega de Valladolid). Pascual Piñera (Hospital Reina Sofía de Murcia). Raquel Torres Garate (Hospital Severo Ochoa). Aitor Alquezar, Miguel Alberto Rizzi (Hospital San Pau de Barcelona). Javier Jacob, Irene Cabello (Hospital Universitari de Bellvitge, Barcelona). Fernando Richard (Complejo Hospitalario de Burgos), Javier Lucas (Hospital General de Albacete). Pablo Herrero, Joaquin Vázquez Alvarez, Ana Alonso Morilla, Andrea Irimia (Hospital Universitario Central de Asturias). Pere Llorens, Patricia Javaloyes, Isis Baño (Hospital General de Alicante). Marta Fuentes, Cristina Gil (Hospital Universitario de Salamanca)..

Author information

Authors and Affiliations

  1. Emergency Department, Hospital Clínic, Villarroel 170, 08036, Barcelona, Catalonia, Spain

    Òscar Miró, Víctor Gil & Rosa Escoda

  2. “Emergencies: Processes and Pathologies” Research Group, Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain

    Òscar Miró, Víctor Gil & Rosa Escoda

  3. Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland

    Christian Müller

  4. Emergency Department, Hospital Clínico San Carlos, Madrid, Spain

    Francisco Javier Martín-Sánchez

  5. Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain

    Francisco Javier Martín-Sánchez

  6. Universidad Complutense de Madrid, Madrid, Spain

    Francisco Javier Martín-Sánchez & Héctor Bueno

  7. Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain

    Héctor Bueno

  8. Instituto de Investigación i+12 y Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain

    Héctor Bueno

  9. Department of Anesthesiology and Critical Care Medicine, Hospital Lariboisière, Université Paris Diderot, Paris, France

    Alexander Mebazaa

  10. Emergency Department, Hospital Universitario Central de Asturias, Oviedo, Spain

    Pablo Herrero

  11. Emergency Department, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain

    Javier Jacob

  12. Emergency Department, Home Hospitalization and Short Stay Unit, Hospital General de Alicante, Alicante, Spain

    Pere Llorens

Authors
  1. Òscar Miró
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christian Müller
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Francisco Javier Martín-Sánchez
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Héctor Bueno
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Alexander Mebazaa
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Pablo Herrero
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Javier Jacob
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Víctor Gil
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Rosa Escoda
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Pere Llorens
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

ICA-SEMES Research Group

Corresponding author

Correspondence to Òscar Miró.

Ethics declarations

Conflict of interests

The authors state that they have no conflict of interests with the present work. ICA-SEMES has received unrestricted support from Orion Pharma and Novartis, and the present work was designed, performed, analyzed and written exclusively by the authors independently of these pharmaceutical laboratories.

Additional information

The members of the ICA-SEMES Research Group are listed in acknowledgments.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Miró, Ò., Müller, C., Martín-Sánchez, F.J. et al. BETAWIN-AHF study: effect of beta-blocker withdrawal during acute decompensation in patients with chronic heart failure. Clin Res Cardiol 105, 1021–1029 (2016). https://doi.org/10.1007/s00392-016-1014-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00392-016-1014-9

Keywords

Search

Navigation