Prognostic value of beta-blocker doses in patients with ventricular tachyarrhythmias

Tobias Schupp,Ahmad Saleh,Sevil Ziyadova,Michael Behnes,Mohammad Abumayyaleh,Mohammed L Abba,Kathrin Weidner,Yusuf Ugur Sag,Ibrahim Akin,Linda Reiser,Thomas Bertsch,Julius Reinhardt,Kambis Mashayekhi,Max Von Zworowsky

doi:10.1007/s00380-021-02018-3

Abstract

The study investigates the prognostic significance of beta-blocker (BB) dose in patients with ventricular tachyarrhythmias. Limited data regarding the prognostic impact of BB dose in ventricular tachyarrhythmias is available. A large retrospective registry was used including consecutive patients on BB treatment with episodes of ventricular tachycardia (VT) or fibrillation (VF) from 2002 to 2015. Discharge BB doses were grouped as > 0–12.5%, > 12.5–25%, > 25–50%, and > 50% according to doses used in randomized trials. The primary endpoint was all-cause mortality at three years. Secondary endpoints comprised of a composite arrhythmic endpoint (i.e., recurrences of ventricular tachyarrhythmias and appropriate ICD therapies) and cardiac rehospitalization. Kaplan–Meier survival curves and multivariable Cox regression analyses were applied for statistics. A total of 1313 patients with BB were included; most patients were discharged with > 25–50% of BB target dose (59%). At three years, > 12.5–25% of BB target dose was associated with improved long-term mortality as compared to the > 0–12.5% group (HR = 0.489; 95% CI 0.297–0.806; p = 0.005), whereas higher BB doses did not improve survival (> 25–50%: HR = 0.849; p = 0.434; > 50%: HR = 0.735; p = 0.285). In contrast, the composite endpoint and risk of rehospitalization were not affected by BB target dose. In conclusion, > 12.5–25% of BB target dose is associated with best long-term survival among patients with ventricular tachyarrhythmias. In contrast, risk of the composite arrhythmic endpoint and risk of cardiac rehospitalization were not affected by BB dose.

Highlights

Beta-blockers (BB) were demonstrated to decrease all-cause mortality and risk of sudden cardiac death (SCD) in various randomized controlled trials (RCT) including patients with systolic heart failure (HF), acute myocardial infarction (AMI) and arterial hypertension [1,2,3]
The present study evaluates the prognosis of patients with ventricular tachyarrhythmias treated with > 0–12.5%, > 12.5–25%, > 25–50%, and > 50% of BB target dose according to doses used in RCT regarding the primary endpoint of all-cause mortality at three years, on the risk of a composite endpoint and cardiac rehospitalization
Only > 12.5–25% of BB target dose was associated with improved all-cause mortality at three years (HR = 0.594; 95% CI 0.359–0.981; p = 0.042)

Summary

Introduction

Beta-blockers (BB) were demonstrated to decrease all-cause mortality and risk of sudden cardiac death (SCD) in various randomized controlled trials (RCT) including patients with systolic heart failure (HF), acute myocardial infarction (AMI) and arterial hypertension [1,2,3]. These studies commonly investigate the prognostic impact of BB therapy for primary prevention of SCD [4]. Using a large registry including patients with ventricular tachyarrhythmias, we recently demonstrated that BB therapy improves survival secondary to ventricular tachyarrhythmias [5]. The prognostic impact of BB therapy may be dose-dependent.

Methods

Results

Conclusion