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Should beta-blocker...
Should beta-blocker therapy be reduced or withdrawn after an episode of decompensated heart failure? Results from COMET
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Metra, M. (author)
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Torp-Pedersen, C. (author)
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Cleland, J. G. (author)
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Di Lenarda, A. (author)
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Komajda, M. (author)
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Remme, W. J. (author)
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Dei Cas, L. (author)
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Spark, P. (author)
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- Swedberg, Karl, 1944 (author)
- Gothenburg University,Göteborgs universitet,Institutionen för medicin, avdelningen för akut och kardiovaskulär medicin,Institute of Medicine, Department of Emergeny and Cardiovascular Medicine
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Poole-Wilson, P. A. (author)
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(creator_code:org_t)
- 2007-08-31
- 2007
- English.
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In: Eur J Heart Fail. - : Wiley. - 1388-9842. ; 9:9, s. 901-9
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Abstract
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- BACKGROUND: It is unclear whether beta-blocker therapy should be reduced or withdrawn in patients who develop acute decompensated heart failure (HF). We studied the relationship between changes in beta-blocker dose and outcome in patients surviving a HF hospitalisation in COMET. METHODS: Patients hospitalised for HF were subdivided on the basis of the beta-blocker dose administered at the visit following hospitalisation, compared to that administered before. RESULTS: In COMET, 752/3029 patients (25%, 361 carvedilol and 391 metoprolol) had a non-fatal HF hospitalisation while on study treatment. Of these, 61 patients (8%) had beta-blocker treatment withdrawn, 162 (22%) had a dose reduction and 529 (70%) were maintained on the same dose. One-and two-year cumulative mortality rates were 28.7% and 44.6% for patients withdrawn from study medication, 37.4% and 51.4% for those with a reduced dosage (n.s.) and 19.1% and 32.5% for those maintained on the same dose (HR,1.59; 95%CI, 1.28-1.98; p<0.001, compared to the others). The result remained significant in a multivariable model: (HR, 1.30; 95%CI, 1.02-1.66; p=0.0318). No interaction with the beneficial effects of carvedilol, compared to metoprolol, on outcome was observed (p=0.8436). CONCLUSIONS: HF hospitalisations are associated with a high subsequent mortality. The risk of death is higher in patients who discontinue beta-blocker therapy or have their dose reduced. The increase in mortality is only partially explained by the worse prognostic profile of these patients.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine (hsv//eng)
Keyword
- Adrenergic beta-Antagonists/*administration & dosage
- Aged
- Carbazoles/*administration & dosage
- Female
- Heart Failure/*drug therapy/*mortality
- Hospitalization
- Humans
- Male
- Metoprolol/*administration & dosage
- Middle Aged
- Prognosis
- Propanolamines/*administration & dosage
- Withholding Treatment
Publication and Content Type
- ref (subject category)
- art (subject category)
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- By the author/editor
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Metra, M.
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Torp-Pedersen, C ...
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Cleland, J. G.
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Di Lenarda, A.
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Komajda, M.
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Remme, W. J.
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show more...
-
Dei Cas, L.
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Spark, P.
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Swedberg, Karl, ...
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Poole-Wilson, P. ...
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show less...
- About the subject
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Cardiac and Card ...
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
- Articles in the publication
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Eur J Heart Fail
- By the university
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University of Gothenburg