The prognostic value of beta blocker dosage and heart rate at discharge among patients with acute decompensation of heart failure with reduced EF

Introduction: While the effect of elevated heart rate (HR) for prognosis and therapy of cardiovascular morbidity and mortality is evident in chronic stable heart failure, data in this regard in acute heart failure setting are scarce and debatable. Although HR lowering is an important effect of beta-blockers, the prognostic benefits are not clearly attributable to reducing HR.

Purpose: In this single-center study, we sought to address the prognostic value of beta-blocker dosage and heart rate at discharge on all-cause mortality and re-hospitalization among patients with and HFrEF and acute decompensated heart failure (ADHF).

Methods: In this retrospective observational study, 2505 patients were admitted for the first time with the primary diagnosis of ADHF between January 2008 and February 2018.

Patients were divided by resting HR at discharge into 3 groups (HR < 70 BPM, HR 70-90 and HR > 90). Evidence-based beta-blockers were defined as metoprolol, bisoprolol, carvedilol and nebivolol. The doses of prescribed beta-blockers were calculated into a percentage target dose of each beta-blocker and divided to four quartiles: less than 25%, 25-50%, 50-75% and more than 75% of the target dose.

Results: At discharge; a total of 1192 patients had a HR less than 70 BPM, 1057 patients had a HR at range 70-90 BPM and 256 patients with a HR more than 90 BPM. The 30-day mortality rate was 4.1%, 4.2% and 9% (p-value 0.002) respectively regardless of the dosage of BB at discharge. Voncordantly, 1-year mortality rate was 14.3%, 14.9% and 22.3% (p-value 0.005) among patients with HR less than 70 BPM, 70-90 BPM and HR more than 90 BPM respectively regardless of the dosage of BB at discharge.

Conclusion: Patients with a HR less than 70 BPM had a better survival at 1-year from discharge regardless of the BB dosage on discharge.