Association of prior beta-blocker use and the outcomes of patients with out-of-hospital cardiac arrest
Czarnecki A, Morrison LJ, Qiu F, Cheskes S, Koh M, Wijeysundera HC, Verbeek PR, Austin PC, Dorian P, Scales DC, Tu JV, Ko DT. Am Heart J. 2015; 170(5):1018-24.e2. Epub 2015 Jul 26.
Background — Beta-blocker therapy is one of the most commonly prescribed treatments for patients with cardiac conditions. In patients with out-of-hospital cardiac arrest (OHCA) however, recent data suggest prior treatment with beta-blockers could be harmful by lowering the incidence of a shockable presenting rhythm. The main objective of our study was to determine the association between prior beta-blocker use and mortality in OHCA patients.
Methods — An observational study was conducted using the Toronto Rescu Epistry database that captured consecutive OHCA patients from 2005 to 2010. Patients older than 65 years with non-traumatic cardiac arrest and attempted resuscitation were included. Patients prescribed beta-blockers within 90 days of the arrest were compared to those without such therapy. The primary outcome was all-cause mortality at 30 days. Potential confounders were accounted for by inverse probability of treatment weighting using the propensity score.
Results — The median age of 8,266 OHCA patients was 79 years, 41% were women, and 2,911 (35.2%) were prescribed a beta-blocker prior to cardiac arrest. Patients prescribed beta-blockers were more likely to have existing cardiac risk factors, and cardiovascular conditions. In the propensity weighted cohort, there were no differences in the presenting rhythm with 18.4% of patients in the beta-blocker group having a shockable rhythm versus 17.5% in the no beta-blocker group (standardized difference 0.023). In addition, 30-day mortality was not significantly different between patients prescribed beta-blockers and no beta-blockers (95.6% vs. 95.1%, p = 0.36).
Conclusion — Beta-blocker use was not associated with lower rates of shockable rhythms or mortality among older patients with OHCA.