| Title: |
Pre-admission beta-blocker therapy and outcomes in cardiogenic shock: Insights from the Altshock-2 Registry |
| Authors: |
Pagnesi, Matteo; Riccardi, Mauro; Sacco, Alice; Tavecchia, Giovanni; Viola, Giovanna; Frea, Simone; Briani, Martina; Bertoldi, Letizia Fausta; Bertaina, Maurizio; Potena, Luciano; Valente, Serafina; Marini, Marco; De Ferrari, Gaetano Maria; D'Ettore, Nicoletta; Cardinale, Astrid; Camporotondo, Rita; Rota, Matteo; Tavazzi, Guido; Morici, Nuccia; Pappalardo, Federico; Metra, Marco |
| Contributors: |
Pagnesi, Matteo; Riccardi, Mauro; Sacco, Alice; Tavecchia, Giovanni; Viola, Giovanna; Frea, Simone; Briani, Martina; Bertoldi, Letizia Fausta; Bertaina, Maurizio; Potena, Luciano; Valente, Serafina; Marini, Marco; De Ferrari, Gaetano Maria; D'Ettore, Nicoletta; Cardinale, Astrid; Camporotondo, Rita; Rota, Matteo; Tavazzi, Guido; Morici, Nuccia; Pappalardo, Federico; Metra, Marco |
| Publisher Information: |
John Wiley & Sons Ltd |
| Publication Year: |
2025 |
| Subject Terms: |
Cardiogenic shock; beta‐blockers; inotropes; mortality; vasopressors |
| Description: |
AimsWe aimed to assess the impact of pre-admission beta-blocker (BB) therapy on the clinical characteristics, in-hospital treatment and outcomes of patients with cardiogenic shock (CS).MethodsAll patients enrolled in the multicentre prospective Altshock-2 registry since March 2020 with available data on pre-admission BB therapy were included. Clinical characteristics, in-hospital management, haemodynamic parameters and clinical outcomes were compared in patients with versus without BB therapy. The primary endpoint was in-hospital mortality.ResultsA total of 668 patients were included [median age 66 (56-74) years, male sex 76.5%]: 299 patients (44.8%) with and 369 patients (55.2%) without previous BB therapy. Patients receiving pre-admission BB therapy had more frequently heart failure-related CS (43.8% vs. 17.9%) and less frequently cardiac arrest at presentation (20.1% vs. 27.8%, P = 0.027). Levosimendan was used less frequently and dobutamine was used more frequently in patients with baseline BB therapy (P = 0.033 and P = 0.043, respectively). Differences in the early haemodynamic response to vasoactive drugs were observed between patients with and without previous BB therapy, with a significant impact of baseline BB on mean arterial pressure (MAP) response during norepinephrine infusion (P = 0.012) and with dobutamine having a reduced response in MAP and heart rate in patients receiving BBs before admission (P = 0.023 and P = 0.001, respectively). In-hospital mortality was not significantly different between the BB and no-BB groups (40% vs. 33.7%; adjusted odds ratio 1.32, 95% confidence interval 0.84-2.07, P = 0.224). Similarly, baseline BB therapy was not independently associated with 48 h mortality (12.7% vs. 14.6%; adjusted odds ratio 1.09, 95% confidence interval 0.64-1.87, P = 0.749). The lack of association between baseline BB therapy and mortality was also confirmed at inverse probability of treatment weighting-adjusted analysis.ConclusionsIn a real-world, contemporary cohort of patients with CS, ... |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| Relation: |
info:eu-repo/semantics/altIdentifier/pmid/40488449; info:eu-repo/semantics/altIdentifier/wos/WOS:001508022400001; volume:12; issue:4; firstpage:2565; lastpage:2577; numberofpages:13; journal:ESC HEART FAILURE; https://hdl.handle.net/20.500.11768/193208; https://academic.oup.com/eschf/article/12/4/2565/8488076?login=false |
| DOI: |
10.1002/ehf2.15322 |
| Availability: |
https://hdl.handle.net/20.500.11768/193208; https://doi.org/10.1002/ehf2.15322; https://academic.oup.com/eschf/article/12/4/2565/8488076?login=false |
| Rights: |
info:eu-repo/semantics/openAccess ; license:Creative commons ; license uri:http://creativecommons.org/licenses/by-nc/4.0/ |
| Accession Number: |
edsbas.29508DF2 |
| Database: |
BASE |