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Cited by 190Heart Failure Treatment and ManagementHeart rate and cardiovascular healthBlood Pressure and Hypertension Studies

Effects of Beta-Blocker Withdrawal in Acute Decompensated Heart Failure

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Prins, Kurt W., Neill, John M., Tyler, John O., Eckman, Peter M., Duval, Sue·2015·JACC: Heart Failure
DOI 10.1016/j.jchf.2015.03.008PMC PMC4777602
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Abstract

Objectives This study sought to evaluate the effects of beta-blocker withdrawal in acute decompensated heart failure (ADHF).Background Published reports showed trends for either no harm or increased risk of in-hospital mortality, short-term mortality, and rehospitalization rates in patients admitted for ADHF that discontinued beta-blockers; however, a comprehensive analysis has not been conducted.Methods Relevant studies from January 2000 through January 2015 were identified in the PubMed, EMBASE, and COCHRANE electronic databases. Where appropriate data were available, weighted relative risks were estimated using random-effects meta-analysis techniques.Results Five observational studies and 1 randomized clinical trial (n = 2,704 patients who continued beta-blocker therapy and n = 439 patients who discontinued beta-blocker therapy) that reported the short-term effects of beta-blocker withdrawal in ADHF were included in the analyses. In 2 studies, beta-blocker withdrawal significantly increased risk of in-hospital mortality (risk ratio: 3.72; 95% confidence interval [CI]: 1.51 to 9.14). Short-term mortality (relative risk: 1.61; 95% CI: 1.04 to 2.49; 4 studies) and combined short-term rehospitalization or death (relative risk: 1.59; 95% CI: 1.03 to 2.45; 4 studies) were also significantly increased.Conclusions Discontinuation of beta-blockers in patients admitted with ADHF was associated with significantly increased in-hospital mortality, short-term mortality, and the combined endpoint of short-term rehospitalization or mortality. These data suggest beta-blockers should be continued in ADHF patients if their clinical picture allows.

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  • β-blockers are primarily used to manage cardiovascular conditions such as hypertension and coronary artery disease, and act by inhibiting β-adrenergic receptors (β-ARs).

    “β-adrenergic antagonists, commonly known as β-blockers, are primarily used to manage cardiovascular conditions such as hypertension and coronary artery disease, and act by inhibiting β-adrenergic receptors (β-ARs) within the adrenergic system.323–325”

    From Drug repurposing for cancer therapy (2024) · cites this paper as [324]

    The paper’s Conclusions (page unavailable) support beta-blocker use in a cardiovascular condition: acute decompensated heart failure. The passages found do not say that beta-blockers are primarily used for hypertension or coronary artery disease, or explain their action as inhibition of β-adrenergic receptors. (LLM, conf=0.83)

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  • A recent meta-analysis of 5 observational studies and 1 randomized trial confirmed that β-blocker withdrawal in the setting of HHF increased the risk of in-hospital mortality (RR, 3.72 [95% CI 1.51-9.14]), mortality at 60-180 days (RR, 1.78 [95% CI 1.13-2.79]), and combined short term rehospitalization or mortality (RR, 1.84 [95% CI 1.08-3.1]).

    “A recent meta-analysis of 5 observational studies and 1 randomized trial confirmed this association; β-blocker withdrawal in the setting of HHF increased the risk of in-hospital mortality (RR, 3.72 [95% CI 1.51-9.14]), mortality at 60-180 days (RR, 1.78; [95% CI 1.13-2.79]), and combined short term rehospitalization or mortality (RR, 1.84; [95% CI 1.08-3.1]).35”

    From CCS/CHFS Heart Failure Guidelines Update: Defining a New Pharmacologic Standard of Care for Heart Failure With Reduced Ejection Fraction (2021) · cites this paper as [35]

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Authors
Prins, K. W., Neill, J. M., Tyler, J. O., Eckman, P. M., & Duval, S.
Affiliations
  • University of Minnesota (US)
  • University of Alabama at Birmingham (US)
Corresponding author
Prins, Kurt W.
ORCID
Venue
JACC: Heart Failure
Publisher
Elsevier BV
Published
2015-08
Volume
3
Issue
8
Pages
647-653
ISSN
2213-1779 (ISSN-L)
DOI
10.1016/j.jchf.2015.03.008
PMC
PMC4777602
OpenAlex
W1057392835
Cited by
190
References
34
Citations by year
2026: 11 · 2025: 24 · 2024: 22 · 2023: 13 · 2022: 23 · 2021: 22 · 2020: 17 · 2019: 14 · 2018: 15 · 2017: 14 · 2016: 11 · 2015: 2 · 2014: 2
FWCI
10.19
Type
journal article
Language
en
Update notices
erratum (2015-10-01)
Open access
Licence
Locations
  • JACC Heart Failure (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Heart, Lung, and Blood Institute (T32HL069764)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart rate and cardiovascular health
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
Keywords
beta-blocker withdrawal, beta-blockers, acute decompensated heart failure, in-hospital mortality, short-term mortality, hospital readmission, heart failure treatment
MeSH terms
Adrenergic beta-Antagonists, Heart Failure, Humans, Substance Withdrawal Syndrome, Survival Rate, Randomized Controlled Trials as Topic, Observational Studies as Topic

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