Prognostic value of beta-blocker doses in patients with ventricular tachyarrhythmias

• Published in: Heart and vessels 2022-07, Vol.37 (7), p.1213-1223
• Main Authors: Schupp, Tobias, Ziyadova, Sevil, Reinhardt, Julius, Sag, Yusuf Ugur, von Zworowsky, Max, Reiser, Linda, Abumayyaleh, Mohammad, Weidner, Kathrin, Saleh, Ahmad, Mashayekhi, Kambis, Bertsch, Thomas, Abba, Mohammed L., Akin, Ibrahim, Behnes, Michael
• Format: Article
• Language: English
• Subjects: Beta blockers; Biomedical Engineering and Bioengineering; Cardiac Surgery; Cardiology; Clinical trials; Fibrillation; Heart; Medicine; Medicine & Public Health; Mortality; Original; Original Article; Patients; Regression analysis; Risk; Survival; Tachycardia; Vascular Surgery; Ventricle
• ISSN: 0910-8327; 1615-2573
• DOI: 10.1007/s00380-021-02018-3

The study investigates the prognostic significance of beta-blocker (BB) dose in patients with ventricular tachyarrhythmias. Limited data regarding the prognostic impact of BB dose in ventricular tachyarrhythmias is available. A large retrospective registry was used including consecutive patients on BB treatment with episodes of ventricular tachycardia (VT) or fibrillation (VF) from 2002 to 2015. Discharge BB doses were grouped as > 0–12.5%, > 12.5–25%, > 25–50%, and > 50% according to doses used in randomized trials. The primary endpoint was all-cause mortality at three years. Secondary endpoints comprised of a composite arrhythmic endpoint (i.e., recurrences of ventricular tachyarrhythmias and appropriate ICD therapies) and cardiac rehospitalization. Kaplan–Meier survival curves and multivariable Cox regression analyses were applied for statistics. A total of 1313 patients with BB were included; most patients were discharged with > 25–50% of BB target dose (59%). At three years, > 12.5–25% of BB target dose was associated with improved long-term mortality as compared to the > 0–12.5% group (HR = 0.489; 95% CI 0.297–0.806; p  = 0.005), whereas higher BB doses did not improve survival (> 25–50%: HR = 0.849; p  = 0.434; > 50%: HR = 0.735; p  = 0.285). In contrast, the composite endpoint and risk of rehospitalization were not affected by BB target dose. In conclusion, > 12.5–25% of BB target dose is associated with best long-term survival among patients with ventricular tachyarrhythmias. In contrast, risk of the composite arrhythmic endpoint and risk of cardiac rehospitalization were not affected by BB dose.