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European Heart Journal Advance Access originally published online on August 30, 2009
European Heart Journal
2009 30(18):2186-2192; doi:10.1093/eurheartj/ehp323
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org

B-CONVINCED: Beta-blocker CONtinuation Vs. INterruption in patients with Congestive heart failure hospitalizED for a decompensation episode

Guillaume Jondeau1,*, Yannick Neuder2, Jean-Christophe Eicher3, Patrick Jourdain4, Elodie Fauveau5, Michel Galinier6, Arnaud Jegou7, Fabrice Bauer8, Jean Noel Trochu9, Anissa Bouzamondo10, Marie-Laure Tanguy10, Philippe Lechat10 for the B-CONVINCED Investigators

1 AP-HP, Hôpital Bichat, Service de Cardiologie, Faculté de médecine Paris VII, INSERM U698, Paris F-75018, France
2 CHU Grenoble, Service de Cardiologie et Hypertension Artérielle, BP 217, Grenoble F-38043, France
3 Hôpital du Bocage, Service de Cardiologie II, Dijon F-21034, France
4 CH René Dubos, Service de Cardiologie, Pontoise F-95301, France
5 Centre Hospitalier Sud Francilien, Service de Cardiologie, CORBEIL Essonnes F-91100, France
6 CHU Rangueil, Service de Cardiologie, Toulouse F-31059, France
7 AP-HP, Hôpital A Paré, Service de Cardiologie, 92100 Boulogne, Billancourt F-92100, France
8 Centre Hospitalier, Service de Cardiologie, F-76031 Rouen, France
9 INSERM, UMR915, l'institut du thorax, Nantes F-44000 France; CHU Nantes, l'institut du thorax, Clinique Cardiologique et des Maladies Vasculaires, Nantes F-44093, France
10 AP-HP, Unité de Recherche Clinique, Pitié Salpêtrière, F-77013 Paris, France

Received 22 June 2009; revised 10 July 2009; accepted 24 July 2009 * Corresponding author. Tel: +33 1 40 25 68 11, Fax: +33 1 40 25 67 32, Email: guillaume.jondeau{at}bch.aphp.fr

See page 2177 for the commentary on this article (doi:10.1093/eurheartj/ehp347)

Aims: Whether or not beta-blocker therapy should be stopped during acutely decompensated heart failure (ADHF) is unsure.

Methods and results: In a randomized, controlled, open labelled, non-inferiority trial, we compared beta-blockade continuation vs. discontinuation during ADHF in patients with LVEF below 40% previously receiving stable beta-blocker therapy. 169 patients were included, among which 147 were evaluable. Mean age was 72 ± 12 years, 65% were males. After 3 days, 92.8% of patients pursuing beta-blockade improved for both dyspnoea and general well-being according to a physician blinded for therapy vs. 92.3% of patients stopping beta-blocker. This was the main endpoint and the upper limit for unilateral 95% CI (6.6%) is lower that of the predefined upper limit (12.5%), indicating non-inferiority. Similar findings were obtained at 8 days and when evaluation was made by the patient. Plasma BNP at Day 3, length of hospital stay, re-hospitalization rate, and death rate after 3 months were also similar. Beta-blocker therapy at 3 months was given to 90% of patients vs. 76% (P < 0.05).

Conclusion: In conclusion, during ADHF, continuation of beta-blocker therapy is not associated with delayed or lesser improvement, but with a higher rate of chronic prescription of beta-blocker therapy after 3 months, the benefit of which is well established.

Key Words: Heart failure • Beta-blockade • Acute heart failure • Systolic dysfunction


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Could we be convinced with B-CONVINCED?
Prabhath Fernando
European Heart Journal, 19 Nov 2009 [Full text]
We should be convinced with B-CONVINCED
Guillaume Jondeau, et al.
European Heart Journal, 19 Nov 2009 [Full text]

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