Clinical outcomes in patients on beta-blocker therapy admitted with worsening chronic heart failure

Beta blockers have been shown to reduce morbidity and mortality in patients with heart failure without evidence of overt congestion. No data are available describing outcomes of patients admitted with exacerbated chronic heart failure who are receiving β blockade at the time of admission. The purpose of this analysis was to evaluate clinical outcomes in patients from the Outcomes of the Prospective Trial of Intravenous Milrinone for Exacerbations of Chronic Heart Failure (OPTIME-CHF) study who were prescribed β blockers on admission compared with patients who were not prescribed β blockers at admission. In all, 212 patients were treated with β blockers at admission and 737 patients were not. Baseline characteristics were similar between groups, except that patients prescribed β blockers on admission had slightly higher ejection fractions, fewer New York Heart Association class IV symptoms, and lower heart rates. There was no difference in clinical events between patients who were treated with β blockers at the time of admission and those who were not. Exploratory analyses suggested that patients whose β-blocker therapy was discontinued had a higher risk of adverse outcomes, particularly in the subset of patients randomized to milrinone. The data from this nonrandom comparison suggest that continuation of pre-existing β-blocker therapy is not associated with an increased risk of adverse clinical events in patients admitted with worsening heart failure. These results also suggest that caution should be taken when withdrawing β blockade in this population.