β-Blockers on Discharge From Acute Atrial Fibrillation Are Associated With Decreased Mortality and Lower Cerebrovascular Accidents in Patients With Heart Failure and Reduced Ejection Fraction
Affiliations
Affiliations
- Department of Medicine and Genetic Medicine, Weill Cornell Medicine-Qatar.
- Adult Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar.
- Department of Medicine, Faculty of Medicine, Kuwait University, Kuwait.
- Department of Medicine, Mubarak Al-Kabeer Hospital, Ministry of Health, Kuwait.
- Mohammed Bin Khalifa Cardiac Centre, Manama, Bahrain.
- Biostatistics Section, Cardiovascular Research, Heart Hospital, Hamad Medical Corporation, Doha, Qatar.
Abstract
The benefits of β-blockers in patients with heart failure (HF) with reduced ejection fraction (HFrEF) and atrial fibrillation (AF) are controversial. The Gulf Survey of Atrial Fibrillation Events was a prospective, multinational, observational registry of consecutive patients with AF recruited from the emergency department (ED). We studied the incidence of 6- and 12-month mortality, hospitalization for HF or AF, and stroke/transient ischemic attacks (TIAs) in patients with HFrEF, in relation to β-blockers on discharge from the ED or the subsequent hospital stay. Of the 344 patients with HFrEF and AF in the GULF-SAFE, 177 patients (53%) were discharged on β-blockers. Mortality was lower in those patients compared with the non-β-blockers group at 6 and 12 months (odds ratios [ORs] 0.31, 95% CI [0.16-0.61]; OR 0.30, 95% CI [0.16-0.55]; P = .001 for both, respectively), so was the risk of stroke/TIAs. However, hospitalizations for AF increased in the β-blockers group. Even after adjustment for several risk variables in 2 different models, the beneficial effect of β-blockers on mortality persisted, at the cost of more hospitalization for AF.
Keywords: atrial fibrillation; cardiovascular mortality; heart failure; stroke; β-blockers.
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