Beta-blockers and cardiovascular outcomes in acute heart failure with a history of coronary artery disease and an ejection fraction ≥ 40.

BACKGROUND: The prognostic impact of beta-blockers (BB) in coronary artery disease (CAD) is controversial, especially in the post-reperfusion era.

OBJECTIVE: To assess whether patients with CAD and heart failure (HF) but without left ventricular dysfunction might benefit from BB use.

METHODS: We studied in-hospital cardiovascular events in patients hospitalized for acute HF, with a previous history of CAD and a left ventricular ejection fraction (LVEF) ≥40%, in relation to BB on admission; and one-year outcome in relation to BB on discharge, in the GULF-CARE, a prospective multicenter cohort of acute HF.

RESULTS: From a total of 5005 patients included in the GULF-CARE registry, 824 had a previous history of CAD and a LVEF ≥40%. 303 patients on BB were propensity-matched to 303 patients without BB. Mean age was 65 (11) and 53% were males. BB did not reduce in-hospital mortality (OR= 0.82; 95%CI [0.35-1.94]), stroke, and cardiogenic shock. On discharge, 306 patients on BB - including the ones newly diagnosed for myocardial infarction as a precipitating cause of HF - were propensity-scored matched with 306 patients without BB. Mortality (OR= 0.86; 95%CI [0.51-1.45], hospitalization for HF or PCI/CABG at 12 months were also were also not reduced by BB use at discharge. Further sensitivity analysis showed that BB treatment was not an independent predictor of in-hospital and 12-month mortality.

CONCLUSION: In this cohort of patients with acute HF, BB do not reduce in-hospital and one-year cardiovascular outcomes in patients with a previous history of CAD and a LVEF ≥40%.