Prior Use Of Beta-blockers Research Articles

Two decades of SVT ablation in Denmark: a trend towards higher age, more comorbidity, and less prior use of antiarrhythmic and rate-limiting pharmacotherapy—a nationwide registry-based Danish study

Background and aimsTrends in patient selection and use of pharmacotherapy prior to catheter ablation (CA) for supraventricular tachycardia (SVT) are not well described. This study examined temporal trends in patients undergoing first-time CA for regular SVT, including atrioventricular nodal re-entry tachycardia (AVNRT), accessory pathways (APs), and ectopic atrial tachycardia (EAT) on a nationwide scale in Denmark in the period 2001–2018.Methods and resultsUsing Danish Nationwide registers, 9959 patients treated with first-time CA for SVT between 2001 and 2018 were identified, of which 6023 (61%) received CA for AVNRT, 2829 (28%) for AP, and 1107 (11%) for EAT. Median age was 55, 42, and 55 in the AVNRT, APs, and EAT group, respectively. The number of patients receiving CA increased from 1195 between 2001 and 2003 to 1914 between 2016 and 2018. The percentage of patients with a CHA2DS2-VASc score ≥ 2 increased in all patient groups. The number of patients who underwent CA with no prior use of antiarrhythmic- or rate limiting medicine increased significantly, though prior use of beta-blockers increased for AVNRT patients. Use of verapamil decreased in all three SVT groups (P < 0.05). Use of amiodarone and class 1C antiarrhythmics remained low, with the highest usage among EAT patients.ConclusionBetween 2001 and 2018, CA was increasingly performed in patients with SVT, primarily AVNRT- and EAT patients. The burden of comorbidities increased. Patients undergoing CA without prior antiarrhythmic- or rate-limiting drug therapy increased significantly. Use of beta-blockers increased and remained the most widely used drug.Graphical

Screening for orthostatic hypotension in the geriatric population in a real-world primary care setting reduces prescribed antihypertensive medications.

To determine if outpatient screening for orthostatic hypotension (OH) in the geriatric population results in fewer prescribed antihypertensive medications and if a relationship exists between OH and specific pharmacologic classes of antihypertensive medications. Patients ≥ 65 years were screened for OH, defined as a decrease in systolic blood pressure (SBP) ≥ 20 mm Hg or a decrease in diastolic blood pressure (DBP) ≥ 10 mm Hg after standing for 3 minutes. Sitting blood pressure (BP) was measured after patients had been seated quietly in an exam room. Patients then stood for approximately 3 minutes at which time standing BP was recorded. OH prevalence was 18%. Standing DBP was significantly different between the two groups (70 mmHg ± 18, 80 mmHg ± 13, P = 0.007). Compared to patients without OH, patients with OH were more likely to have been previously prescribed beta-blockers (56% vs. 32%, P = 0.056) and potassium-sparing diuretics (11% vs. 1%, P = 0.026). Physicians discontinued an antihypertensive medication more often in patients who screened positive for OH than in to those who did not (17% vs. 4%, P = 0.037). Calcium channel blockers were the most frequently discontinued class of medication. Asymptomatic OH is prevalent in geriatric patients. Screening for OH may lead to de-escalation of antihypertensive regimen and a reduction in polypharmacy. Positive screening for OH was associated with de-prescribing of antihypertensive medications. Prior use of beta-blockers and potassium-sparing diuretics was most largely associated with OH.

Beta blockers reduce uterine fibroid incidence in hypertensive women

ObjectiveIs prior beta blocker (BB) use associated with reduced odds of the clinical incidence of leiomyomas? What is known alreadyIn-vitro and in-vivo evidence has supported the role of beta receptor blockade in reducing leiomyoma cell proliferation and growth. However, no population-based study to date has investigated this potential association. Study design, size, durationA nested case-control study was conducted in a population of women aged 18–65 with arterial hypertension (n = 699,966). Cases (n = 18,918) with a leiomyoma diagnosis were matched to controls (n = 681,048) with no such diagnosis at a 1:36 ratio by age and region of origin within the United States. Participants/materials, setting, methodsThis population was assembled from the Truven Health MarketScan® Research Database, which includes health insurance claims from January 1st, 2012 to December 31st, 2017. Prior use of BB wasdetermined fromoutpatient drug claims and leiomyoma development was indicated by a first-time diagnosis code. We conducted a conditional logistic regression to determine the odds of uterine fibroid development in women with prior use of BB compared to women with no such history. We then conducted subset analyses, stratifying the women by age group and by type of BB. ResultsWomen on a BB experienced 15% reduced odds of developing clinically recognized leiomyoma compared to non-users (OR 0.85, 95% CI 0.76–0.94). This association was significant for the 30–39 age group (OR 0.61, 95% CI 0.40–0.93) but no other age group. Of the BBs, propranolol (OR 0.58, 95% CI 0.36–95) demonstrated a significant association with reduced leiomyoma incidence and metoprolol (OR 0.82, 95% CI 0.70–0.97) was associated with lower uterine fibroid incidence after adjustment for comorbidities. ConclusionsHypertensive women with prior BB use experienced reduced odds of developing clinically recognized leiomyoma compared to non-users. A key predisposing risk factor for uterine leiomyoma is elevated blood pressure. Thus, the results of this analysis may have clinical relevance to women with hypertension, as the use of this drug may introduce a dual benefit of managing hypertension as well as curbing an increased risk of leiomyomas.

Effect of prior beta-blocker use on in-hospital atrial fibrillation development in patients with ST-elevation myocardial infarction

ABSTRACT Background and Aim There are conflicting results about the early administration of beta-blockers (bb) on in-hospital mortality and arrhythmias. Here, we wanted to investigate the effects of chronic bb use on in-hospital Atrial Fibrillation (AF) development in ST-Elevation Myocardial Infarction (STEMI) patients. Materials and Methods A total of 814 consecutive patients with STEMI were included in the study. They were divided into two groups according to whether they are using bb on admission or not. They were followed for AF development in-hospital and predictors of AF were determined by multivariable logistic regression analysis. Results Of the 814 patients, 103 (12.67%) patients were already using bb, while 711 (87.3%) were not. There were no significant differences in the frequency of AF development [3 (%2.9) vs 30 (%4.2), p = .788] between the groups. Multivariable logistic regression analysis showed that left atrial (LA) diameter is the only independent predictor of in-hospital AF development. Conclusions Our study showed that chronic bb use does not have an effect on in-hospital AF development in STEMI patients. Nevertheless, LA diameter was found to be an independent predictor of AF.

Analysis of Patient Perceptions of Possible Triggers of Acute Myocardial Infarction

Studies using case-crossover methodology have shown that stressors such as physical exertion, emotional stress, heavy meals, and respiratory infection can trigger acute myocardial infarction (AMI). However, patients may differ in their perception of what triggered their heart attack, which in turn influences the potential for a triggered acute risk prevention strategy. In this prospective, observational cohort study, adult patients with AMI and confirmed obstructive coronary disease underwent interviews which included an open-ended question asking what they thought may have triggered their AMI. Of 874 patients, 399 (45.7%) identified a possible trigger, while 475 (54.3%) did not identify a trigger. Possible triggers included emotional stress (24.7%), physical exertion (10.9%), non-respiratory illnesses (3%), heavy meals (2.3%), medication changes (1.5%), alcohol (1.4%), fatigue (1.4%), respiratory infection (0.8%), sexual activity (0.3%), cocaine (0.1%), and caffeine (0.1%). Smoking was identified as a possible trigger by 56 patients (6.4%). 55 patients (6.1%) identified >1 possible trigger. Prior beta blocker use was associated with a lower likelihood of identifying emotional stress as a trigger (OR 0.53, 95% CI 0.29–0.96, p=0.035). Almost half of patients (45.7%) identified a possible trigger of AMI, although 6.4% who identified smoking may have been uncertain regarding what would generally be regarded as a chronic risk factor. Emotional stress was the most frequently identified trigger (24.7%), with reduced reporting by those on prior beta blockers. Further study of triggers and their modifiers may provide insight into novel approaches to prevention.

Effect of long-term beta-blocker treatment following myocardial infarction among stable, optimally treated patients without heart failure in the reperfusion era: a Danish, nationwide cohort study.

We aimed to investigate the long-term cardio-protective effect associated with beta-blocker (BB) treatment in stable, optimally treated myocardial infarction (MI) patients without heart failure (HF). Using nationwide registries, we included patients with first-time MI undergoing coronary angiography (CAG) or percutaneous coronary intervention (PCI) during admission and treated with both acetyl-salicylic acid and statins post-discharge between 2003 and 2018. Patients with prior history of MI, prior BB use, or any alternative indication or contraindication for BB treatment were excluded. Follow-up began 3 months following discharge in patients alive, free of cardiovascular (CV) events or procedures. Primary outcomes were CV death, recurrent MI, and a composite outcome of CV events. We used adjusted logistic regression and reported standardized absolute risks and differences (ARD) 3 years after MI. Overall, 30177 stable, optimally treated MI patients were included (58% acute PCI, 26% sub-acute PCI, 16% CAG without intervention). At baseline, 82% of patients were on BB treatment (median age 61 years, 75% male) and 18% were not (median age 62 years, 68% male). BB treatment was associated with a similar risk of CV death, recurrent MI, and the composite outcome of CV events compared with no BB treatment [ARD (95% confidence intervals)] correspondingly; 0.1% (-0.3% to 0.5%), 0.2% (-0.7% to 1.2%), and 1.2% (-0.2% to 2.7%). In this nationwide cohort study of stable, optimally treated MI patients without HF, we found no long-term effect of BB treatment on CV prognosis following the patients from 3 months to 3 years after MI admission.

Predictive factors for long-term mortality and role of comorbidities in cardiogenic shock

Despite advances in intensive care medicine, the treatment of cardiogenic shock (CS) is still far from perfect with high residual mortality rates regardless of etiology. Predictive data regarding long-term (LT) mortality rates in patients presenting CS is sparse. Early detection of high-risk patients is a major challenge to intensify the management and improve the outcomes even in the LT. In total, 275 CS patients admitted to our center (CHU de Toulouse) between 01/2013 and 12/2014 were retrospectively reviewed. Mortality was recorded by telephone in 12/2016. The cox proportional hazards model was used to determine LT predictors of mortality. Patients were male (76%) with an average age of 64 (± 15.5) and a history of cardiomyopathy (63%) mainly ischemic (42%). Leading causes of CS were post-myocardial infarction (35%) decompensated heart failure (34%), and post-cardiac arrest (21%). On December 2016, the mortality rate was 62.5%. After multivariate analysis, we identified prior use of beta-blockers (HR: 0.62 [95% CI: 0.42–0.91]; P = 0.02) and initial coronary angiography exploration (HR: 0.60 [95% CI: 0.4–0.92]; P = 0.02) as protective factors. Conversely, age (HR: 1.02 per year [95% CI: 1.01–1.04]; P < 0.001), catecholamine support (HR: 1.37 for one additional agent more [95% CI: 1.19–1.57]; P < 0.001), and renal replacement support (HR: 1.64 [95% CI: 1.07–2.51]; P = 0.02) were associated with increased LT mortality ( Fig. 1 ). The LT mortality of CS remains high. In terms of LT survival, prior use of beta-blockers and coronary angiography exploration has a protective role, while age, renal insufficiency, and use of inotropic agents, seem to worsen the prognosis.

Does Prior Use of Beta Blockers Affect Functional Outcomes Post Ischemic Stroke Endovascular Intervention? (P5.296)

Does Prior Use of Beta Blockers Affect Functional Outcomes Post Ischemic Stroke Endovascular Intervention? (P5.296)

Effect of chronic pretreatment with beta-blockers on no-reflow phenomenon in diabetic patients with acute ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention.

BackgroundNo-reflow is an important factor as it predicts a poor outcome in patients undergoing primary angioplasty. In comparison with patients attaining TIMI 3 flow, patients with no-reflow have an increased incidence of ventricular arrhythmias, early congestive cardiac failure, cardiac rupture and cardiac death. As such, it is of paramount importance to consider strategies to prevent the occurrence of no-reflow phenomenon. Previous evidence suggests that Beta (β) blockers have multiple favorable effects on the vascular system not directly related to their effect on blood pressure. However, there are insufficient data regarding the effects of prior Beta blocker use on coronary blood flow after primary PCI in patients with AMI.AimThe aim of this study was to test the hypothesis that Beta blocker treatment before admission would have beneficial effects on the development of the no-reflow phenomenon after acute myocardial infarction.Methods and resultsThe study included 107 diabetic patients who had presented with acute STEMI within 12 h from the onset of chest pain. All of them have undergone primary angioplasty at Ain Shams University hospitals or National Heart institute. The incidence of no-reflow phenomenon was 21%. No-reflow phenomenon was significantly lower in patients on chronic B-blocker therapy (12% vs. 28%; P = 0.04). The heart rate was significantly lower in the normal reflow group than in the no-reflow group (P = 0.03). The study also showed that B-blocker pretreatment is an independent protective predictor for the no-reflow phenomenon (P = 0.045).ConclusionChronic pre-treatment with B-blocker in diabetic patients presenting with STEMI, is associated with lower rate of occurrence of no-reflow phenomenon after primary PCI.

119 - Cardiogenic shock: place of comorbidities and prior use of beta-blockers

119 - Cardiogenic shock: place of comorbidities and prior use of beta-blockers

Beta-Blockers for Exams Identify Students at High Risk of Psychiatric Morbidity.

Beta-blockers relieve the autonomic symptoms of exam-related anxiety and may be beneficial in exam-related and performance anxiety, but knowledge on related psychiatric outcomes is unknown. We hypothesized that beta-blocker therapy for exam-related anxiety identifies young students at risk of later psychiatric events. Using Danish nationwide administrative registries, we studied healthy students aged 14-30 years (1996-2012) with a first-time claimed prescription for a beta-blocker during the exam period (May-June); students who were prescribed a beta-blocker for medical reasons were excluded. We matched these students on age, sex, and time of year to healthy and study active controls with no use of beta-blockers. Risk of incident use of antidepressants, incident use of other psychotropic medications, and suicide attempts was examined by cumulative incidence curves for unadjusted associations and multivariable cause-specific Cox proportional hazard analyses for adjusted hazard ratios (HRs). We identified 12,147 healthy students with exam-related beta-blocker use and 12,147 matched healthy students with no current or prior use of beta-blockers (median age, 19 years; 80.3% women). Among all healthy students, 0.14% had a first-time prescription for a beta-blocker during the exam period with the highest proportion among students aged 19 years (0.39%). Eighty-one percent of the students filled only that single prescription for a beta-blocker during follow-up. During follow-up, 2225 (18.3%) beta-blocker users and 1400 (11.5%) nonbeta-blocker users were prescribed an antidepressant (p < 0.0001); 1225 (10.1%) beta-blocker users and 658 (5.4%) nonbeta-blocker users were prescribed a psychotropic drug (p < 0.0001); and 16 (0.13%) beta-blocker users and 6 (0.05%) nonbeta-blocker users attempted suicide (p = 0.03). Exam-related beta-blocker use was associated with an increased risk of antidepressant use (adjusted HRs, 1.68 [95% confidence intervals (CIs), 1.57-1.79], p < 0.0001), other psychotropic medication use (HR, 1.93 [95% CI, 1.76-2.12] p < 0.0001), and suicide attempts (HR, 2.67 [95% CI, 1.04-6.82] p = 0.04). In healthy students, use of beta-blockers during the exam period was associated with an increased risk of psychiatric outcomes and might identify psychologically vulnerable students who need special attention.

Effectiveness of Prior Use of Beta-Blockers for Preventing Adverse Influences of Severe Hypoglycemia in Patients With Diabetes

[This corrects the article DOI: 10.1097/MD.0000000000001629.].

Effectiveness of Prior Use of Beta-Blockers for Preventing Adverse Influences of Severe Hypoglycemia in Patients With Diabetes: An Observational Study.

The study aimed to identify predictors of severe acute hypertension (≥180/110 mmHg) during severe hypoglycemia and to assess the efficacy of prior use of catecholamine-blocking agents for preventing adverse influences in diabetic patients with severe hypoglycemia. We performed a retrospective study between January 2006 and March 2012 to assess diabetic patients with severe hypoglycemia at a single center in Japan. Severe hypoglycemia was defined as the presence of any hypoglycemic symptoms that required the medical assistance of another person after visiting the emergency room by ambulance. Multivariate logistic regression analysis was performed to identify possible predictors of severe hypertension due to severe hypoglycemia and to assess whether prior use of alpha- or beta-blockers is beneficial for the prevention of severe hypertension in diabetic patients with severe hypoglycemia. Multivariate adjustments were made for age, sex, preexisting hypertension, history of ischemic heart disease, blood glucose level upon arrival, estimated GFR, and prior use of alpha- or beta-blockers. A total of 59,602 patients who visited the emergency room were screened and 352 diabetic patients with severe hypoglycemia were enrolled. Incidences of severe hypertension before and at 3 and 6 hours after the initiation of antihypoglycemic treatment were 21.3%, 6.7%, and 0% in patients with type 1 diabetes (n = 61) and 38.8%, 18.2%, and 8.2% in patients with type 2 diabetes (n = 291), respectively. Aging was positively (odds ratio [OR], 1.02; 95% confidence interval [CI], 1.00−1.03; P = 0.02) and female sex was negatively (OR, 0.50; 95% CI, 0.29−0.86; P = 0.01) associated with occurrence of severe hypertension during severe hypoglycemia. In addition, prior use of beta-blockers was negatively associated with occurrence of severe hypertension during severe hypoglycemia using multivariate logistic regression analysis (OR, 0.31; 95% CI, 0.11−0.83; P = 0.02). None of the patients with prior use of beta-blockers had hypokalemia (<3.0 mEq/L). Prior use of beta-blockers may prevent adverse influences such as severe hypertension and hypokalemia during severe hypoglycemia in diabetic patients.

Abstract T MP80: Prior Beta Blocker Use is Associated with Favorable Outcome in Patients with Acute Insular Stroke

BACKGROUND: Sympathetic nervous system activation during acute ischemic stroke (AIS) can lead to a number of undesirable changes such as hyperglycemia, left ventricular stunning, and immunosuppression and thereby could potentially result in worsening of clinical and tissue outcome. We hypothesized that prior beta blocker (BB) use could be beneficial in patients with AIS by opposing increased sympathetic activity. METHODS: This was a consecutive study of patients with AIS conducted as a part of an ongoing prospective NIH-funded study (Heart-Brain Interactions Study). The relationship between BB use within 24 hours prior to stroke onset and outcome measured by modified Rankin Score (mRS) at 3 months was tested using multiple logistic regression. Infarcts including the insula and/or the surrounding opercular cortex were classified “insular”. RESULTS: There were 402 BB-users and 612 BB non-users. BB-users were older and more often had vascular risk factors such as coronary artery disease, atrial fibrillation, and congestive heart failure. Univariate analyses revealed that prior BB use was associated with decreased probability of good outcome (OR 0.72, 95% CI 0.55 - 0.93 for mRS&lt;3). A multivariable analysis adjusting for differences between BB-users and BB non-users showed that BB use was not a predictor of either good or bad outcome (OR 1.33, 95% CI 0.90 - 1.96). However, there was a significant interaction between BB use and insular infarction (p=0.04). A second multivariable model also including the interaction term showed that prior BB use was a significant predictor of favorable outcome in patients with infarcts including the insula (OR 2.21, 95% CI 1.03 - 4.75). CONCLUSIONS: These findings suggest that BB therapy may be beneficial in selected patients with AIS whose infarcts encompass the insula.

Prior beta Blocker Use Is Associated with Favorable Outcome in Patients with Acute Insular Stroke (P01.217)

Prior beta Blocker Use Is Associated with Favorable Outcome in Patients with Acute Insular Stroke (P01.217)

P216 Impact of Tachycardia and New Onset Atrial Fibrillation in Acute Exacerbations of COPD

Introduction and ObjectivesCardiac arrhythmias are regularly found in patients with COPD, with higher frequencies reported during exacerbations. We wished to examine the impact of tachycardia and new onset atrial fibrillation...

Impact of Acute Beta-Blocker Therapy for Patients with Non–ST-Segment Elevation Myocardial Infarction

Purpose Early use of beta-blockers is a quality indicator for the treatment of patients with non–ST-segment elevation myocardial infarction (NSTEMI), despite limited data from randomized clinical trials in this population. We sought to determine the impact of acute beta-blocker therapy on outcomes in patients with NSTEMI. Subjects and Methods We examined acute (<24 hours) beta-blocker use in 72,054 patients with NSTEMI from the Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the American College of Cardiology/American Heart Association Guidelines (CRUSADE) initiative at 509 US hospitals from 2001-2004. We analyzed patient and provider factors associated with beta-blocker use and the impact of beta-blocker therapy on unadjusted, risk-adjusted, and propensity matched outcomes in the overall sample and among selected high-risk subgroups. Results A total of 82.5% of patients without documented contraindications received acute beta-blocker therapy. Factors strongly associated with acute beta-blocker use included prior beta-blocker use, higher presenting systolic blood pressure, lower heart rate, lack of signs of heart failure, and cardiology care. Acute beta-blocker use was associated with lower in-hospital mortality (unadjusted 3.9% vs 6.9%, P <.001, adjusted odds ratio 0.66, 95% confidence interval 0.60-0.72), lower adjusted mortality among most of 6 subgroups determined by propensity to receive acute beta-blockers, and lower adjusted mortality in patients with and without signs of heart failure and in those <80 years and those ≥80 years old. Conclusions The majority of NSTEMI patients receive acute beta-blocker therapy. Certain patient subgroups remain undertreated. Because treatment with acute beta-blockers was associated with improved clinical outcomes in nearly all patient subgroups assessed, broader use in patients with NSTEMI appears warranted.

Grade 3 ischemia on admission and absence of prior beta-blockade predict failure of ST resolution following thrombolysis for anterior myocardial infarction

Background ST segment resolution (STR) is a strong predictor of outcome following thrombolysis. If failure of STR could be predicted on admission, better selection of treatment may be possible. Among patients given reperfusion, those with terminal QRS distortion (grade 3 ischemia) have larger infarcts, but the mechanism underlying this association is unclear. Whether grade 3 ischemia on admission can predict STR is unknown. Methods We studied 180 consecutive patients given thrombolysis for a first anterior acute myocardial infarction (AMI). Multiple variables available on admission were analyzed as predictors of STR at 1, 2, and 24 h and as predictors of the need for rescue percutaneous coronary intervention (PCI). Results Multivariate predictors of failure of STR were: for 1 h: extent of ST elevation (OR: 1.09 [1.01–1.18]); for 2 h: no previous use of beta-blockers (OR: 4.71 [1.56–13.98]) and grade 3 ischemia (OR: 6.77 [3.27–13.95]); for 24 h: previous use of aspirin (OR: 6.70 [1.31–34.01]) and grade 3 ischemia (OR: 29.44 [7.30–118.1]). Grade 3 ischemia had a strong positive predictive value for failure of STR at 1 and 2 h and was the strongest predictor of the need for rescue PCI. Conclusions Grade 3 ischemia on admission is the strongest independent predictor of failure to achieve myocardial reperfusion after thrombolysis. This association may underlie the larger infarcts associated with grade 3 ischemia. Other predictors of reperfusion failure are the extent of ST segment elevation, prior use of aspirin and no prior use of beta-blockers.