B-CONVINCED

Beta-blocker CONtinuation Vs. INterruption in patients with Congestive heart failure hospitalizED for a decompensation episode

Jondeau, Guillaume
Neuder, Yannick
Eicher, Jean-Christophe
Jourdain, Patrick
Fauveau, Elodie
Galinier, Michel
Jegou, Arnaud
Bauer, Fabrice
Trochu, Jean Noel
Bouzamondo, Anissa
Tanguy, Marie-Laure
Lechat, Philippe

¹AP-HP, Hôpital Bichat, Service de Cardiologie, Faculté de médecine Paris VII, INSERM U698, Paris F-75018, France
²CHU Grenoble, Service de Cardiologie et Hypertension Artérielle, BP 217, Grenoble F-38043, France
³Hôpital du Bocage, Service de Cardiologie II, Dijon F-21034, France
⁴CH René Dubos, Service de Cardiologie, Pontoise F-95301, France
⁵Centre Hospitalier Sud Francilien, Service de Cardiologie, CORBEIL Essonnes F-91100, France
⁶CHU Rangueil, Service de Cardiologie, Toulouse F-31059, France
⁷AP-HP, Hôpital A Paré, Service de Cardiologie, 92100 Boulogne, Billancourt F-92100, France
⁸Centre Hospitalier, Service de Cardiologie, F-76031 Rouen, France
⁹INSERM, UMR915, l'institut du thorax, Nantes F-44000 France; CHU Nantes, l'institut du thorax, Clinique Cardiologique et des Maladies Vasculaires, Nantes F-44093, France
¹⁰AP-HP, Unité de Recherche Clinique, Pitié Salpêtrière, F-77013 Paris, France

Received 22 June 2009; revised 10 July 2009; accepted 24 July 2009

See page 2177 for the commentary on this article (doi:10.1093/eurheartj/ehp347)

^*Corresponding author. Tel: +33 1 40 25 68 11, Fax: +33 1 40 25 67 32, Email: [email protected]

European Heart Journal 30(18):p 2186-2192, September 2009.

Aims

Whether or not beta-blocker therapy should be stopped during acutely decompensated heart failure (ADHF) is unsure.

Methods and results

In a randomized, controlled, open labelled, non-inferiority trial, we compared beta-blockade continuation vs. discontinuation during ADHF in patients with LVEF below 40% previously receiving stable beta-blocker therapy. 169 patients were included, among which 147 were evaluable. Mean age was 72 ± 12 years, 65% were males. After 3 days, 92.8% of patients pursuing beta-blockade improved for both dyspnoea and general well-being according to a physician blinded for therapy vs. 92.3% of patients stopping beta-blocker. This was the main endpoint and the upper limit for unilateral 95% CI (6.6%) is lower that of the predefined upper limit (12.5%), indicating non-inferiority. Similar findings were obtained at 8 days and when evaluation was made by the patient. Plasma BNP at Day 3, length of hospital stay, re-hospitalization rate, and death rate after 3 months were also similar. Beta-blocker therapy at 3 months was given to 90% of patients vs. 76% (P < 0.05).

Conclusion

In conclusion, during ADHF, continuation of beta-blocker therapy is not associated with delayed or lesser improvement, but with a higher rate of chronic prescription of beta-blocker therapy after 3 months, the benefit of which is well established.