Should beta-blocker therapy be reduced or withdrawn after an episode of decompensated heart failure? Results from COMET

Background: It is unclear whether beta-blocker therapy should be reduced or withdrawn in patients who develop acute decompensated heart failure (HF). We studied the relationship between changes in beta-blocker dose and outcome in patients surviving a HF hospitalisation in COMET. Methods: Patients ho...

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Bibliographic Details
Published in:European journal of heart failure 2007-09, Vol.9 (9), p.901-909
Main Authors: Metra, Marco, Torp-Pedersen, Christian, Cleland, John G.F., Di Lenarda, Andrea, Komajda, Michel, Remme, Willem J., Cas, Livio Dei, Spark, Philip, Swedberg, Karl, Poole-Wilson, Philip A.
Format: Article
Language:English
Subjects:
Adrenergic beta-Antagonists - administration & dosage
Aged
beta-blockers
Carbazoles - administration & dosage
Cardiac and Cardiovascular Systems
Clinical Medicine
decompensated heart failure
Female
Heart Failure - drug therapy
Heart Failure - mortality
Heart Failure/drug therapy/mortality
Hospitalization
Humans
Kardiologi
Klinisk medicin
Male
Metoprolol - administration & dosage
Middle Aged
Prognosis
Propanolamines - administration & dosage
trials
Withholding Treatment
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Summary:Background: It is unclear whether beta-blocker therapy should be reduced or withdrawn in patients who develop acute decompensated heart failure (HF). We studied the relationship between changes in beta-blocker dose and outcome in patients surviving a HF hospitalisation in COMET. Methods: Patients hospitalised for HF were subdivided on the basis of the beta-blocker dose administered at the visit following hospitalisation, compared to that administered before. Results: In COMET, 752/3029 patients (25%, 361 carvedilol and 391 metoprolol) had a non-fatal HF hospitalisation while on study treatment. Of these, 61 patients (8%) had beta-blocker treatment withdrawn, 162 (22%) had a dose reduction and 529 (70%) were maintained on the same dose. One-and two-year cumulative mortality rates were 28.7% and 44.6% for patients withdrawn from study medication, 37.4% and 51.4% for those with a reduced dosage (n.s.) and 19.1% and 32.5% for those maintained on the same dose (HR,1.59; 95%CI, 1.28-1.98; p
ISSN:1388-9842
1879-0844
DOI:10.1016/j.ejheart.2007.05.011