Role of beta-blockers in patients admitted for worsening heart failure in a real world setting: data from the Italian Survey on Acute Heart Failure

Aims Randomized trials have shown that beta-blockers (BBs) reduce mortality in chronic heart failure (HF). Less data are available on the role of BBs in patients with acute HF, specifically if BBs should be continued or temporarily withdrawn. The aim of this study was to evaluate the role of BBs on in-hospital outcomes of patients admitted for worsening HF in a Cardiology setting. Methods and results One thousand five hundred and seventy-two patients enrolled in the Italian Survey on Acute HF were evaluated. According to the BB therapy before and during hospitalization, four groups were defined: group A, no/no (51.6%); group B, no/yes (16.4%); group C, yes/no (9.0%); and group D, yes/yes (23.0%). Groups B and D had a significantly lower in-hospital mortality rate (group B 1.2%, group D 2.8%, group A 10.1%, and group C 12.1%; P < 0.0001). The association between non-use or withdrawal of BBs and higher mortality rate was confirmed by the multivariable analysis [group D, reference group; odds ratio (OR) 3.28, 95% confidence interval (CI) 1.47-7.32 and OR 4.20, 95% CI 1.59-11.10 for groups A and C, respectively], whereas no difference was found between groups B and D (OR 0.34, 95% CI 0.07-1.78). Conclusion In patients hospitalized for worsening HF, non-use or discontinuation of BBs was associated with a significant higher mortality.