Beta Blockers Improve Prognosis When Used Early in Patients with Cardiogenic Shock: An Analysis of the FRENSHOCK Multicenter Prospective Registry
Background: Beta blockers (BBs) are a cornerstone for patients with heart failure (HF) and ventricular dysfunction. However, their use in patients recovering from a cardiogenic shock (CS) remains a bone of contention, especially regarding whether and when to reintroduce this class of drugs. Methods:...
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-12-01
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| Series: | Pharmaceuticals |
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| Online Access: | https://www.mdpi.com/1424-8247/16/12/1740 |
| _version_ | 1797379751013253120 |
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| author | Laura Sofia Cardelli Miloud Cherbi Fabien Huet Guillaume Schurtz Eric Bonnefoy-Cudraz Edouard Gerbaud Laurent Bonello Guillaume Leurent Etienne Puymirat Gianni Casella Clément Delmas François Roubille |
| author_facet | Laura Sofia Cardelli Miloud Cherbi Fabien Huet Guillaume Schurtz Eric Bonnefoy-Cudraz Edouard Gerbaud Laurent Bonello Guillaume Leurent Etienne Puymirat Gianni Casella Clément Delmas François Roubille |
| author_sort | Laura Sofia Cardelli |
| collection | DOAJ |
| description | Background: Beta blockers (BBs) are a cornerstone for patients with heart failure (HF) and ventricular dysfunction. However, their use in patients recovering from a cardiogenic shock (CS) remains a bone of contention, especially regarding whether and when to reintroduce this class of drugs. Methods: FRENSHOCK is a prospective multicenter registry including 772 CS patients from 49 centers. Our aim was to compare outcomes (1-month and 1-year all-cause mortality) between CS patients taking and those not taking BBs in three scenarios: (1) at 24 h after CS; (2) patients who did or did not discontinue BBs within 24 h; and (3) patients who did or did not undergo the early introduction of BBs. Results: Among the 693 CS included, at 24 h after the CS event, 95 patients (13.7%) were taking BB, while 598 (86.3%) were not. Between the groups, there were no differences in terms of major comorbidities or initial CS triggers. Patients receiving BBs at 24 h presented a trend toward reduced all-cause mortality both at 1 month (aHR = 0.61, 95% CI 0.34 to 1.1, <i>p</i> = 0.10) and 1 year, which was, in both cases, not significant. Compared with patients who discontinued BBs at 24 h, patients who did not discontinue BBs showed lower 1-month mortality (aHR = 0.43, 95% CI 0.2 to 0.92, <i>p</i> = 0.03) and a trend to lower 1-year mortality. No reduction in outcomes was observed in patients who underwent an early introduction of BB therapy. Conclusions: BBs are drugs of first choice in patients with HF and should also be considered early in patients with CS. In contrast, the discontinuation of BB therapy resulted in increased 1-month all-cause mortality and a trend toward increased 1-year all-cause mortality. |
| first_indexed | 2024-03-08T20:27:34Z |
| format | Article |
| id | doaj.art-f35cfd286382482fb1312d966c4cb812 |
| institution | Directory Open Access Journal |
| issn | 1424-8247 |
| language | English |
| last_indexed | 2024-03-08T20:27:34Z |
| publishDate | 2023-12-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Pharmaceuticals |
| spelling | doaj.art-f35cfd286382482fb1312d966c4cb8122023-12-22T14:31:45ZengMDPI AGPharmaceuticals1424-82472023-12-011612174010.3390/ph16121740Beta Blockers Improve Prognosis When Used Early in Patients with Cardiogenic Shock: An Analysis of the FRENSHOCK Multicenter Prospective RegistryLaura Sofia Cardelli0Miloud Cherbi1Fabien Huet2Guillaume Schurtz3Eric Bonnefoy-Cudraz4Edouard Gerbaud5Laurent Bonello6Guillaume Leurent7Etienne Puymirat8Gianni Casella9Clément Delmas10François Roubille11Cardiology Department, Ospedale Versilia, 55049 Camaiore, ItalyIntensive Cardiac Care Unit, Rangueil University Hospital, 31059 Toulouse, FranceDepartment of Cardiology, Centre Hospitalier Bretagne Atlantique, 56000 Vannes, FranceDepartment of Cardiology, Urgences et Soins Intensifs de Cardiologie, CHU Lille, University of Lille, Inserm U1167, 59000 Lille, FranceIntensive Cardiac Care Unit, Lyon Brom University Hospital, 69677 Lyon, FranceIntensive Cardiac Care Unit and Interventional Cardiology, Hôpital Cardiologique du Haut Lévêque, 5 Avenue de Magellan, 33604 Pessac, FranceIntensive Care Unit, Department of Cardiology, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Aix-Marseille University, 13015 Marseille, FranceDepartment of Cardiology, CHU Rennes, Inserm, LTSI—UMR 1099, Univ Rennes 1, 35000 Rennes, FranceAssistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, 75015 Paris, FranceCardiology Department, Ospedale Maggiore, 40131 Bologna, ItalyIntensive Cardiac Care Unit, Rangueil University Hospital, 31059 Toulouse, FrancePhyMedExp, INSERM, CNRS, Cardiology Department, INI-CRT, Université de Montpellier, 34295 Montpellier, FranceBackground: Beta blockers (BBs) are a cornerstone for patients with heart failure (HF) and ventricular dysfunction. However, their use in patients recovering from a cardiogenic shock (CS) remains a bone of contention, especially regarding whether and when to reintroduce this class of drugs. Methods: FRENSHOCK is a prospective multicenter registry including 772 CS patients from 49 centers. Our aim was to compare outcomes (1-month and 1-year all-cause mortality) between CS patients taking and those not taking BBs in three scenarios: (1) at 24 h after CS; (2) patients who did or did not discontinue BBs within 24 h; and (3) patients who did or did not undergo the early introduction of BBs. Results: Among the 693 CS included, at 24 h after the CS event, 95 patients (13.7%) were taking BB, while 598 (86.3%) were not. Between the groups, there were no differences in terms of major comorbidities or initial CS triggers. Patients receiving BBs at 24 h presented a trend toward reduced all-cause mortality both at 1 month (aHR = 0.61, 95% CI 0.34 to 1.1, <i>p</i> = 0.10) and 1 year, which was, in both cases, not significant. Compared with patients who discontinued BBs at 24 h, patients who did not discontinue BBs showed lower 1-month mortality (aHR = 0.43, 95% CI 0.2 to 0.92, <i>p</i> = 0.03) and a trend to lower 1-year mortality. No reduction in outcomes was observed in patients who underwent an early introduction of BB therapy. Conclusions: BBs are drugs of first choice in patients with HF and should also be considered early in patients with CS. In contrast, the discontinuation of BB therapy resulted in increased 1-month all-cause mortality and a trend toward increased 1-year all-cause mortality.https://www.mdpi.com/1424-8247/16/12/1740betablockercardiogenic shockacute heart failureone-month mortalityone-year mortality |
| spellingShingle | Laura Sofia Cardelli Miloud Cherbi Fabien Huet Guillaume Schurtz Eric Bonnefoy-Cudraz Edouard Gerbaud Laurent Bonello Guillaume Leurent Etienne Puymirat Gianni Casella Clément Delmas François Roubille Beta Blockers Improve Prognosis When Used Early in Patients with Cardiogenic Shock: An Analysis of the FRENSHOCK Multicenter Prospective Registry Pharmaceuticals betablocker cardiogenic shock acute heart failure one-month mortality one-year mortality |
| title | Beta Blockers Improve Prognosis When Used Early in Patients with Cardiogenic Shock: An Analysis of the FRENSHOCK Multicenter Prospective Registry |
| title_full | Beta Blockers Improve Prognosis When Used Early in Patients with Cardiogenic Shock: An Analysis of the FRENSHOCK Multicenter Prospective Registry |
| title_fullStr | Beta Blockers Improve Prognosis When Used Early in Patients with Cardiogenic Shock: An Analysis of the FRENSHOCK Multicenter Prospective Registry |
| title_full_unstemmed | Beta Blockers Improve Prognosis When Used Early in Patients with Cardiogenic Shock: An Analysis of the FRENSHOCK Multicenter Prospective Registry |
| title_short | Beta Blockers Improve Prognosis When Used Early in Patients with Cardiogenic Shock: An Analysis of the FRENSHOCK Multicenter Prospective Registry |
| title_sort | beta blockers improve prognosis when used early in patients with cardiogenic shock an analysis of the frenshock multicenter prospective registry |
| topic | betablocker cardiogenic shock acute heart failure one-month mortality one-year mortality |
| url | https://www.mdpi.com/1424-8247/16/12/1740 |
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