Patterns of β-blocker intensification in ambulatory heart failure patients and shortterm association with hospitalization
BMC Cardiovascular Disorders, 06/20/2012
Allen LA et al. – While beta–blockers were intensified in nearly half of patients following hospital discharge and high starting dose was associated with increased readmission risk, the prevailing finding was that readmission events were rarely preceded by β–blocker intensification. These data suggest that β–blocker intensification is not a major precipitant of hospitalization, provided recommended dosing is followed.Methods
- Authors described β–blocker intensification among Kaiser Colorado enrollees with a primary discharge diagnosis of HF between 2001–2009.
- They then assessed beta–blocker intensification in the 30 days prior to first hospital readmission for cases compared to the same time period following index hospitalization for non–rehospitalized matched controls.
- In separate analysis of the subgroup initiated on β–blocker after index hospital discharge, they compared adjusted rates of 30–day hospitalization following initiation of high versus low dose β–blocker.
- Among 3,227 patients, median age was 76 years and 37% had ejection fraction [less than or equal to]40%. (LVSD).
- During a median follow up of 669 days, 14% were never on β–blocker, 21% were initiated on β–blocker, 43% were discharged on β–blocker but never uptitrated, and 22% had discharge beta–blocker uptitrated; 63% were readmitted and 49% died.
- β–blocker intensification occurred in the 30 days preceding readmission for 39 of 1,674 (2.3%) readmitted cases compared to 27 (1.6%) of matched controls (adjusted OR 1.36, 95% CI 0.81–2.27).
- Among patients initiated on therapy, readmission over the subsequent 30 days occurred in 6 of 155 (3.9%) prescribed high dose and 9 of 513 (1.8%) prescribed low dose β–blocker (adjusted OR 3.10, 95% CI 1.02–9.40).
- For the subgroup with LVSD, findings were not significantly different.