Influence of β‐Blocker Continuation or Withdrawal on Outcomes in Patients Hospitalized With Heart Failure: Findings From the OPTIMIZE‐HF Program

.  Objectives.  This study ascertains the relationship between continuation or withdrawal of β‐blocker therapy and clinical outcomes in patients hospitalized with systolic heart failure (HF). Background.  Whether β‐blocker therapy should be continued or withdrawn during hospitalization for decompensated HF has not been well studied in a broad cohort of patients. Methods.  The Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure (OPTIMIZE‐HF) enrolled 5791 patients admitted with HF in a registry with prespecified 60‐ to 90‐day follow‐up at 91 academic and community hospitals throughout the United States. Outcomes data were prospectively collected and analyzed according to whether β‐blocker therapy was continued, withdrawn, or not started. Results.  Among 2373 patients eligible for β‐blockers at discharge, there were 1350 (56.9%) who were receiving β‐blockers before admission and continued on therapy, 632 (26.6%) were newly started, 79 (3.3%) in whom therapy was withdrawn, and 303 (12.8%) were eligible but not treated. Continuation of β‐blockers was associated with a significantly lower risk and propensity‐adjusted postdischarge death (hazard ratio [HR], 0.60; 95% confidence interval [CI], 0.37–0.99; P =.044) and death/rehospitalization (odds ratio, 0.69; 95% CI, 0.52–0.92; P =.012) compared with no β‐blocker. In contrast, withdrawal of β‐blocker use in patients was associated with a substantially higher adjusted risk for mortality compared with those continued on β‐blockers (HR, 2.3; 95% CI, 1.2–4.6; P =.013) but with similar risk as HF patients eligible but not treated with β‐blockers. Conclusions.  The continuation of β‐blocker therapy in patients hospitalized with decompensated HF is associated with lower postdischarge mortality risk and improved treatment rates. In contrast, withdrawal of β‐blocker therapy is associated with worse risk and propensity‐adjusted mortality.— Fonarow GC, Abraham WT, Albert NM, et al; for the OPTIMIZE‐HF investigators. Influence of beta‐blocker continuation or withdrawal on outcomes in patients hospitalized with heart failure: findings from the OPTIMIZE‐HF program . J Am Coll Cardiol. 2008;52(3):190–199.