Journal of the American Heart Association, 2019. 8(4), e011121-, DOI: https://doi.org/10.1161/JAHA.118.011121

β-Blockers and 1-Year Postdischarge Mortality for Heart Failure and Reduced Ejection Fraction and Slow Discharge Heart Rate

Jin Joo Park, Hyun-Ah Park;Hyun-Jai Cho;Hae-Young Lee;Kye Hun Kim;Byung-Su Yoo;Seok-Min Kang;Sang Hong Baek;Eun-Seok Jeon;Jae-Joong Kim;Myeong-Chan Cho;Shung Chull Chae;Byung-Hee Oh;Dong-Ju Choi

Abstract

Background

Many hospitalized patients with heart failure and reduced ejection fraction (HFrEF) have a slow heart rate atdischarge, and the effect of b-blockers may be reduced in those patients. We sought to examine the variable effect of b-blockerson clinical outcomes according to the discharge heart rate of hospitalized HFrEF patients.

Methods and Results

The KorAHF (Korean Acute Heart Failure) registry consecutively enrolled 5625 patients hospitalized foracute heart failure. In this analysis, we included patients with HFrEF (left ventricular ejection fraction ≤40%). Slow heart rate wasdefined as <70 beats per minute regardless of the use of b-blockers. The primary outcome was 1-year all-cause postdischarge deathaccording to heart rate. Among 2932 patients with HFrEF, 840 (29%) had a slow heart rate and 56% received b-blockers at discharge.Patients with slow heart rates were older and had lower 1-year mortality than those with high heart rates (P<0.001). A significantinteraction between discharge heart rate and b-blocker use was observed (P<0.001 for interaction). When stratified, only patientswithout a b-blocker preion and with a high heart rate showed higher 1-year mortality. In a Cox-proportional hazards regressionanalysis, b-blocker preion at discharge was associated with 24% reduced risk for 1-year mortality in patients with high heartrates (hazard ratio: 0.76; 95% CI, 0.61–0.95) but not in those with slow heart rates (hazard ratio: 1.02; 95% CI, 0.68–1.55).

Conclusions

Many patients with acute heart failure have slow discharge heart rates, and b-blockers may have a limited effect onHFrEF and slow discharge heart rate.

• DOI: https://doi.org/10.1161/JAHA.118.011121
• ISBN or ISSN: 2047-9980

• 본 연구는 질병관리본부 연구개발과제연구비를 지원받아 수행되었습니다.
• This research was supported by a fund by Research of Korea Centers for Disease Control and Prevention.