RELATION BETWEEN BETA-ADRENERGIC BLOCKER USE, VARIOUS CORRELATES OF LEFT-VENTRICULAR FUNCTION AND THE CHANCE OF DEVELOPING CONGESTIVE-HEART-FAILURE

This study examined the relations among beta-adrenergic blocker use, various correlates of left ventricular function and the chance of developing congestive heart failure in patients after myocardial infarction. The study was performed with the placebo group of the Multicenter Diltiazem Post-Infarction Trial. Ejection fraction data were available in 1,084 patients; of these, 557 were receiving a beta-blocker and 527 were not. In addition to ejection fraction, other correlates of left ventricular function included the presence or absence of pulmonary rales, chest X-ray film evidence of pulmonary congestion and the presence of an S3 gallop. Beta-blocker use was less frequent in patients with an ejection fraction <30%, rales, an S3 gallop and pulmonary congestion on chest X-ray film. Twenty-one percent of patients with an ejection fraction <30%, 42% of patients with rales, 28% of patients with an S3 gallop and 28% of patients with pulmonary congestion were receiving beta-blocker therapy. For every correlate of left ventricular function, the chance of developing congestive heart failure was greater in patients with diminished left ventricular function than in those without. For each level of left ventricular function, the chance of developing congestive heart failure requiring treatment was greater in patients not taking a beta-Mocker. The 2.5 year risk of congestive heart failure for patients receiving beta-blocker therapy was 46% for those with ejection fraction <30%, 23% for those with rales, 45% for those with S3 gallop and 37% for those with pulmonary congestion; the risk for patients not receiving beta-blocker therapy was 61%, 43%, 55% and 52.5%, respectively. The mortality risk was less for patients receiving beta-blocker therapy for every correlate of left ventricular function except S3 gallop. The 2.5 year risk of death for patients receiving beta-blocker therapy was 23.5% for those with ejection fraction <30%, 16% for those with rales, 40.5% for those with S3 gallop and 13% for those with pulmonary congestion; the mortality risk for patients not taking a beta-blocker was 45%, 24%, 27% and 30%, respectively. These results, together with other information, may encourage the cautious use of beta-blockers in patients with decreased left ventricular function. © 1990.