In-hospital use of beta-blockers for critically ill patients with acute heart failure: Whether and when to initiate

In-hospital use of beta-blockers for critically ill patients with acute heart failure: Whether and when to initiateDOI: 10.1016/j.jclinane.2025.111824 AbstractBackground: The use of beta-blockers during hospitalization for acute heart failure (AHF) remains controversial. This study aimed to investigate whether beta-blocker use isassociated with a reduced risk of mortality in critically ill patients with AHF and to determine the optimal timing for initiating beta-blocker therapy. Methods: Data from critically ill patients with AHF in the MIMIC-IV version 2.2 database were analyzed.Baseline characteristics, laboratory tests, comorbidities, vital signs, and medication usage at admission and during hospitalization were collected to performinverse probability of treatment weighting (IPTW). IPTW-weighted logistic regression models were then used to examine the relationship between beta-blocker use and mortality. Results: In the IPTW-weighted regression model, patients who newly started beta-blockers or continued theiruse had a lower risk of in-hospital mortality compared to those not treated with beta-blockers (oddsratio [OR]: 0.45; 95 % confidence interval [CI]: 0.34 to 0.61, and OR: 0.53; 95 % CI: 0.41 to 0.69, respectively). Conversely, those who had beta-blockers withdrawn showed a higher risk of in-hospital mortality (OR: 2.59; 95 % CI: 1.63 to4.10). Among beta-blocker users, compared to patients treated before admission and who received their first dose within 48 h of admission, those whowere not treated before admission but started after 48 h had a similar mortality risk (OR: 0.82; 95 % CI: 0.60 to 1.11; P = 0.202). However, patients previously treated with beta-blockers who initiated therapy after 48 h and those not treated before admission but started within 48 h had a lower risk of in-hospital mortality (OR: 0.44; 95 % CI: 0.30 to 0.64; P < 0.001, and OR: 0.65; 95 % CI: 0.48 to 0.86; P = 0.003,respectively). Conclusion: The use of beta-blockers during hospitalization for AHF is associated with a reduced risk of in-hospital mortality, and withdrawal was associated with an increased risk of mortality. Initiating beta-blockers within 48 h for beta-blocker-naïve patients and after 48 h for those previously treated with beta-blockers before admission may further decrease mortality risk. Disclaimer:Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STARUPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.