Continuation versus discontinuation of beta-blockers during hospitalisation for viral pneumonia in patients with COPD and HFrEF
F Zhang, S Mehta, E Ni, C Bolanos, W Pike, Z AmmariAbstract
Background / Introduction
β-blockers are cornerstone therapy for heart failure with reduced ejection fraction (HFrEF); however, they are frequently discontinued during hospitalization for acute viral pneumonia in patients with coexisting chronic obstructive pulmonary disease (COPD) due to concerns regarding bronchospasm and hemodynamic instability. Evidence guiding β-blocker management during acute viral pneumonia in patients with both COPD and HFrEF is scarce, and contemporary guidelines provide limited direction, resulting in highly variable practice.
Purpose
To evaluate the association between continuation versus discontinuation of β-blocker therapy during hospitalization and clinical outcomes in patients with viral pneumonia, COPD, and HFrEF.
Methods
We conducted a retrospective cohort study using a United States de-identified electronic health record and claims database (2015–2024). Adults hospitalized for ≥2 days with viral pneumonia, COPD, and HFrEF who had an active β-blocker prescription within 90 days prior to admission were included. Exposure was continuation of home β-blocker therapy during hospitalization (≥1 inpatient dose within days 0–2) versus discontinuation. Outcomes included cardiovascular complications, length of stay (LOS), and 30- and 90-day readmission. Propensity score matching was applied to adjust for baseline differences.
Results
Among 7,462 eligible patients, propensity score matching resulted in a balanced cohort of 1,552 patients (776 per group). In the matched cohort, β-blocker continuation was associated with a lower 30-day readmission rate compared with discontinuation (36.3% vs 43.0%; adjusted OR 0.73, 95% CI 0.59–0.89; p=0.002) and a shorter length of stay (adjusted IRR 0.88, 95% CI 0.80–0.96; p=0.005). A non-significant trend towards lower 90-day readmission was observed (53.9% vs 57.6%; adjusted OR 0.83, 95% CI 0.68–1.01; p=0.066). No increase in ICU transfer was observed (adjusted OR 0.86, 95% CI 0.69–1.06; p=0.149; Figure 1).
Conclusion(s)
In patients with HFrEF and COPD hospitalized with viral pneumonia, continuation rather than routine discontinuation of β-blockers was associated with reduced 30-day readmission and shorter hospital stay without excess adverse events. These findings support consideration of β-blocker continuation during acute viral respiratory illness in this high-risk population.Figure 1For image description, please refer to the figure legend and surrounding text.