Beta-Blockers and Cardiovascular Outcomes in Acute Heart Failure with a History of Coronary Artery Disease and an Ejection Fraction ≥ 40%

Author(s): Charbel Abi Khalil*, Kadhim Sulaiman, Nidal Asaad, Khalid F. AlHabib, Alawi Alsheikh-Ali, Mohammed Jameesh, Mohammed Al-Jarallah, Bassam Bulbanat, Wael AlMahmeed, Mustafa Ridha, Nooshin Bazargani, Haitham Amin, Ahmed Al-Motarreb, Husam AlFaleh, Prashanth Panduranga, Ziyad Mahfoud, Jassim Al Suwaidi

Journal Name: Current Vascular Pharmacology

Volume 18 , Issue 6 , 2020


Become EABM
Become Reviewer
Call for Editor

Graphical Abstract:


Abstract:

The prognostic impact of beta-blockers (BB) in coronary artery disease (CAD) is controversial, especially in the post-reperfusion era. We studied in-hospital cardiovascular events in patients hospitalized for acute HF, a previous history of CAD and a left ventricular ejection fraction (LVEF) ≥40%, in relation to BB on admission; and 1-year outcome in relation to BB on discharge, in the GULF aCute heArt failuRe (GULF-CARE) registry. From a total of 5005 patients included in the GULF-CARE registry, 303 patients with a previous history of CAD and a LVEF ≥40% on BB were propensity-matched to 303 patients without BB on admission. In-hospital mortality (OR= 0.82; 95% CI [0.35-1.94]), stroke and cardiogenic shock were not reduced by BB. On discharge, 306 patients on BB, including the ones newly diagnosed with myocardial infarction as a precipitating cause of HF, were propensity-scored matched with 306 patients without BB. Mortality (OR= 0.86; 95%CI [0.51-1.45], hospitalization for HF or PCI/CABG at 1 year were also not reduced by BB at discharge. In summary, our data show that BB have a neutral effect on in-hospital and 1-year outcomes in acute heart failure patients with a previous history of CAD and a LVEF ≥40%.

Keywords: Heart failure, beta-blockers, left ventricular ejection fraction, mortality, cardiovascular disease, coronary artery disease.

[1]
Chatterjee S, Biondi-Zoccai G, Abbate A, et al. Benefits of β blockers in patients with heart failure and reduced ejection fraction: network meta-analysis. BMJ 2013; 346: f55.
[http://dx.doi.org/10.1136/bmj.f55] [PMID: 23325883]
[2]
Chatterjee S, Chaudhuri D, Vedanthan R, et al. Early intravenous beta-blockers in patients with acute coronary syndrome--a meta-analysis of randomized trials. Int J Cardiol 2013; 168(2): 915-21.
[http://dx.doi.org/10.1016/j.ijcard.2012.10.050] [PMID: 23168009]
[3]
Bangalore S, Makani H, Radford M, et al. Clinical outcomes with β-blockers for myocardial infarction: a meta-analysis of randomized trials. Am J Med 2014; 127(10): 939-53.
[http://dx.doi.org/10.1016/j.amjmed.2014.05.032] [PMID: 24927909]
[4]
Puymirat E, Riant E, Aissaoui N, et al. β-Blockers and mortality after myocardial infarction in patients without heart failure: multicentre prospective cohort study. BMJ 2016; 354: i4801.
[http://dx.doi.org/10.1136/bmj.i4801] [PMID: 27650822]
[5]
Redfield MM. Heart failure with preserved ejection fraction. N Engl J Med 2016; 375(19): 1868-77.
[http://dx.doi.org/10.1056/NEJMcp1511175] [PMID: 27959663]
[6]
Oghlakian GO, Sipahi I, Fang JC. Treatment of heart failure with preserved ejection fraction: have we been pursuing the wrong paradigm? Mayo Clin Proc 2011; 86(6): 531-9.
[http://dx.doi.org/10.4065/mcp.2010.0841] [PMID: 21576513]
[7]
Abi Khalil C, AlHabib KF, Singh R, et al. β-Blocker therapy prior to admission for acute coronary syndrome in patients without heart failure or left ventricular dysfunction improves in-hospital and 12-month outcome: results from the GULF-RACE 2 (Gulf Registry of Acute Coronary Events-2). J Am Heart Assoc 2017; 6(12): e007631.
[http://dx.doi.org/10.1161/JAHA.117.007631] [PMID: 29263035]
[8]
Sulaiman K, Panduranga P, Al-Zakwani I, et al. Clinical characteristics, management, and outcomes of acute heart failure patients: observations from the Gulf acute heart failure registry (Gulf CARE). Eur J Heart Fail 2015; 17(4): 374-84.
[http://dx.doi.org/10.1002/ejhf.245] [PMID: 25739882]
[9]
Braunwald E. The war against heart failure: the Lancet lecture. Lancet 2015; 385(9970): 812-24.
[http://dx.doi.org/10.1016/S0140-6736(14)61889-4] [PMID: 25467564]
[10]
Abi Khalil C, Al Suwaidi J, Singh R, et al. Beta-Blockers are associated with decreased in-hospital mortality and stroke in acute decompensated heart failure: findings from a retrospective analysis of a 22-year registry in the Middle East (1991-2013). Curr Vasc Pharmacol 2017; 15(1): 77-83.
[http://dx.doi.org/10.2174/1570161114666160822155440] [PMID: 27550053]
[11]
Abi Khalil C, Sulaiman K, Mahfoud Z, et al. Non-withdrawal of beta blockers in acute decompensated chronic and de novo heart failure with reduced ejection fraction in a prospective multicentre study of patients with acute heart failure in the Middle East. BMJ Open 2017; 7(7): e014915.
[http://dx.doi.org/10.1136/bmjopen-2016-014915] [PMID: 28694343]
[12]
Yancy CW, Jessup M, Bozkurt B, et al. 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. Circulation 2013; 128(16): e240-327.
[http://dx.doi.org/10.1161/CIR.0b013e31829e8776] [PMID: 23741058]
[13]
McMurray JJ, Adamopoulos S, Anker SD, et al. Task force for the diagnosis and treatment of acute and chronic heart failure 2012 of the European society of cardiology; esc committee for practice guidelines. 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 J Heart Fail 2012; 14(8): 803-69.
[http://dx.doi.org/10.1093/eurjhf/hfs105] [PMID: 22828712]
[14]
Fukuta H, Goto T, Wakami K, Ohte N. The effect of beta-blockers on mortality in heart failure with preserved ejection fraction: A meta-analysis of observational cohort and randomized controlled studies. Int J Cardiol 2017; 228: 4-10.
[http://dx.doi.org/10.1016/j.ijcard.2016.11.239] [PMID: 27863360]
[15]
van Veldhuisen DJ, Cohen-Solal A, Böhm M, et al. Beta-blockade with nebivolol in elderly heart failure patients with impaired and preserved left ventricular ejection fraction: Data from SENIORS (Study of Effects of Nebivolol Intervention on Outcomes and Rehospitalization in Seniors With Heart Failure). J Am Coll Cardiol 2009; 53(23): 2150-8.
[http://dx.doi.org/10.1016/j.jacc.2009.02.046] [PMID: 19497441]
[16]
Yamamoto K, Origasa H, Hori M, Investigators JD. Effects of carvedilol on heart failure with preserved ejection fraction: the Japanese diastolic heart failure study (J-DHF). Eur J Heart Fail 2013; 15(1): 110-8.
[http://dx.doi.org/10.1093/eurjhf/hfs141] [PMID: 22983988]
[17]
Martin N, Manoharan K, Thomas J, Davies C, Lumbers RT. Beta-blockers and inhibitors of the renin-angiotensin aldosterone system for chronic heart failure with preserved ejection fraction. Cochrane Database Syst Rev 2018; 6: CD012721.
[http://dx.doi.org/10.1002/14651858.CD012721.pub2] [PMID: 29952095]
[18]
Kiselev AR, Shvartz VA, Karavaev AS, et al. Correlations between cardiovascular autonomic control indices during the two-hour immobilization test in healthy subjects. Open Cardiovasc Med J 2016; 10: 35-43.
[http://dx.doi.org/10.2174/1874192401610010035] [PMID: 27053965]
[19]
Kiselev AR, Gridnev VI, Prokhorov MD, et al. Selection of optimal dose of beta-blocker treatment in myocardial infarction patients based on changes in synchronization between 0.1 Hz oscillations in heart rate and peripheral microcirculation. J Cardiovasc Med (Hagerstown) 2012; 13(8): 491-8.
[http://dx.doi.org/10.2459/JCM.0b013e3283512199] [PMID: 22343262]
[20]
Floras JS, Ponikowski P. The sympathetic/parasympathetic imbalance in heart failure with reduced ejection fraction. Eur Heart J 2015; 36(30): 1974-82.
[http://dx.doi.org/10.1093/eurheartj/ehv087] [PMID: 25975657]
[21]
Zhang DY, Anderson AS. The sympathetic nervous system and heart failure. Cardiol Clin 2014; 32(1): 33-45.
[http://dx.doi.org/10.1016/j.ccl.2013.09.010] [PMID: 24286577]
[22]
Lohse MJ, Engelhardt S, Eschenhagen T. What is the role of beta-adrenergic signaling in heart failure? Circ Res 2003; 93(10): 896-906.
[http://dx.doi.org/10.1161/01.RES.0000102042.83024.CA] [PMID: 14615493]
[23]
Borlaug BA, Paulus WJ. Heart failure with preserved ejection fraction: pathophysiology, diagnosis, and treatment. Eur Heart J 2011; 32(6): 670-9.
[http://dx.doi.org/10.1093/eurheartj/ehq426] [PMID: 21138935]


Rights & PermissionsPrintExport Cite as

Article Details

VOLUME: 18
ISSUE: 6
Year: 2020
Page: [644 - 651]
Pages: 8
DOI: 10.2174/1570161118666191231114203
Price: $65

Article Metrics

PDF: 29
HTML: 3