Objectives: Beta-blocker therapy is recommended for most patients with chronic heart failure, although such therapy may be discontinued or reduced during hospitalizations. The aim is to determine whether β-blocker use at study entry and/or at discharge has an impact on 31- and 180-day survival.
Design: Survival of Patients With Acute Heart Failure in Need of Intravenous Inotropic Support study was designed as a randomized, double-blind, active-controlled, multi-center study.
Patients: A total of 1,327 critically ill patients hospitalized with low-output heart failure in need of inotropic therapy.
Intervention: Levosimendan versus dobutamine.
Measurements: All-cause mortality at 31 and 180 days in patients who survived initial hospitalization with/without β-blocker use at entry and/or at discharge.
Results: Patients on β-blockers at entry and at discharge had significantly lower 31-day (p < .0001) and 180-day (p < .0001) mortality compared to patients without β-blockers use at both time points. The association was robust when adjusted for age and co-morbidities (p = .006 at 31 days; p = .003 at 180 days).
Conclusions: Those results strongly suggest, in severe acutely decompensated heart failure patients, admitted on β-blockers, to continue on them at discharge.
From the Klinik für Innere Medizin III (MB, AL), Universitätsklinikum des Saarlandes, Homburg/Saar, Germany; Abbott Laboratories (DC, BH, RJP), Abbott Park, IL; the Division of Cardiology (MSN), Helsinki University Central Hospital, Helsinki, Finland; the Department of Cardiology (GSF), Athens University Hospital, Athens, Greece; the Department of Anesthesiology and Critical Care Medicine (RS, ACS, AM), Hospital Lariboisière, AP-HP, Paris, France; University Paris 7 Diderot (ACS, AM), Paris, France; UMR-S 942 Inserm (ACS, AM), Paris France; and Orion Phrama (MK), Espoo Finland.
Dr. Böhm received research grants and speakers' honoraria from AstraZeneca, Boehringer Ingelheim, Sanofi-Aventis, Servier, and Pfizer. Dr. Cai is employed by Abbott Laboratories. Dr. Solal is a member of the Steering Committee of the SURVIVE study granted by Abbott Laboratories. Dr. Huang is employed by Abbott Laboratories. Dr. Padley is employed by Abbott Laboratories and also holds stock ownership and stock options with Abbott Laboratories. Dr. Kivikko is employed by Orien Pharma. Dr. Mebazaa consulted for and received honoraria/speaking fees from Abbott Laboratories. The remaining authors have not disclosed any potential conflicts of interest. Drs. Nieminen, Filippatos, Solal, and Mebazaa served as members of the Steering Committee for the Survival of Patients With Acute Heart Failure in Need of Intravenous Inotropic Support (SURVIVE) Trial, which was funded by a grant from Abbott Laboratories. Dr. Padley is an Abbott employee and Dr. Kivikko is an Orion employee who both participated in the design of the SURVIVE trial. Other Abbott employees are Drs. Cai and Huang, who conducted statistical analyses for post hoc and subgroup analyses.
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