In-hospital beta-blocker aids heart failure

NEW YORK (Reuters Health) - Patients hospitalized for heart failure (HF) appear to have better outcomes if they are treated with beta-blockers prior to, during, and after the hospitalization, investigators report.

HF is the progressive inability of the heart to pump enough blood to support vital organs and often leads to a buildup of fluid, causing swollen legs and arms, fatigue and eventually excess fluid in the lungs and severe life-threatening shortness of breath. Standard treatment includes diuretics.

Previous research has demonstrated the safety of starting a beta-blocker for patients with HF, but those studies tended to include outpatients.

Dr. Javed Butler, from Vanderbilt University Medical Center in Nashville, Tennessee, and his associates performed a post-hoc analysis of a large trial that included 432 HF patients.

A total of 268 patients were on beta-blockers at admission, but these were discontinued during hospitalization in 54. In all, 263 survived to discharge, with 209 prescribed a beta-blocker upon discharge.

Patients on preadmission beta-blocker therapy had a shorter length of stay and lower 180-day mortality rate, the team reports in the Journal of the American College of Cardiology. After adjusting for patient characteristics and predictors of mortality, there remained a trend toward lower 180-day mortality.

The authors then compared outcomes for those on beta-blockers when admitted and when discharged, versus those in whom beta-blocker therapy was stopped before discharge. Those who continued the drugs had a lower rate of hospitalization or death at day 180.

Comparing patients discharged on beta-blocker therapy and those not, the 180-day death or rehospitalization rate was 59 percent versus 69 percent.

Thus, the data indicate that beta-blocker use before, during and after hospitalization was safe and associated with better outcomes, Butler's group indicates.

SOURCE: Journal of the American College of Cardiology June 20, 2006.