Continuing treatment reduces death risk, rehospitalization rates, study finds
FRIDAY, July 11 (HealthDay News) -- People who are hospitalized for severe heart failure and have been taking beta blockers should be kept on those medications while in the hospital, a new study finds.
And if they weren't taking beta blockers already, most of them should be started on the medications when they leave, according to a report in the July 15 issue of the Journal of the American College of Cardiology.
The multi-center study of 2,373 people with heart failure severe enough for them to suffer decompensated heart failure, in which they suffer fluid retention, shortness of breath and other complications, is the latest in the back-and-forth story about the role of beta blockers in heart failure, which is the progressive loss of the heart's ability to pump blood.
Beta blockers reduce the activity of adrenaline, and so make the heart beat slower. It was first thought that they were no help against heart failure, said Dr. James B. Young, chairman of the department of medicine at the Cleveland Clinic Lerner College of Medicine and a member of the research team, but experience has shown otherwise. They now are widely prescribed for the condition.
"But many questions abound, including the best treatment strategy in the hospital," Young said. "The best treatment strategy has been hard to define for hospitalized patients. These are tough questions we haven't had a lot of evidence about."
The new study shows a clear benefit for continuing the drug. More than half of the people hospitalized for heart failure were already taking beta blockers. Continuing that drug therapy reduced the risk of death by 40 percent and of going back into the hospital by 31 percent. Discontinuing beta blocker therapy more than doubled the risk of death.
"This is a very important message that beta blockers are an important therapy for heart failure," said Dr. Mihai Gheorghiade, a professor of medicine at Northwestern University Feinberg School of Medicine and a member of the research group.
Gheorghiade was a leader of a study several years ago which showed that hospitalized heart failure patients who were not taking beta blockers benefited from having the therapy started before they left the hospital. The new study supports the view that "it is safe and effective to start beta blockers before discharge," at least in most cases, he said.
"If there are severe signs and symptoms before discharge, you have to think twice," Gheorghiade said. "A patient who is not severely decompensated, with a heart rate below 40 or 50, you can start the drug before discharge."
The new study could have a wide application, Young noted. About 1 million Americans are hospitalized each year because of heart failure, he said. And it marks a complete reversal in what was once the common belief, that beta blockers would harm people with heart failure.
"If you are on a beta blocker and are admitted with decompensated heart failure, it is best not to stop the drug, as had been commonly thought recently," Young said.
Learn about beta blockers and other drugs for heart failure from the American Heart Association.
SOURCES: James B. Young, M.D., chairman, department of medicine, Cleveland Clinic Lerner College of Medicine, Ohio; Mihai Gheorghiade, M.D., professor, medicine, Feinberg School of medicine, Northwestern University, Chicago; July, 15, 2008, Journal of the American College of Cardiology
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