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Original article
Early β-blocker use and in-hospital mortality in patients with Takotsubo cardiomyopathy
  1. Toshiaki Isogai1,2,
  2. Hiroki Matsui1,
  3. Hiroyuki Tanaka2,
  4. Kiyohide Fushimi3,
  5. Hideo Yasunaga1
  1. 1Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
  2. 2Department of Cardiology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
  3. 3Department of Health Policy and Informatics, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
  1. Correspondence to Dr Toshiaki Isogai, Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan; toisogai-circ{at}umin.ac.jp

Abstract

Objective A catecholamine-mediated mechanism has been implicated in the pathogenesis of Takotsubo cardiomyopathy (TC). However, the impact of β-blockers in acute-phase management of TC remains uncertain. This study aimed to examine whether early β-blocker use in TC was associated with lower in-hospital mortality.

Methods This was a retrospective cohort study using the Diagnosis Procedure Combination nationwide inpatient database in Japan. Patients with TC aged ≥20 years who were admitted to acute-care hospitals between 2010 and 2014 were identified. Thirty-day in-hospital mortality was compared between patients who started β-blocker therapy on hospitalisation day 1 or 2 (early β-blocker group) and those who did not receive a β-blocker during hospitalisation (control group) using propensity score-matching and instrumental variable analyses.

Results Of 2672 eligible patients (female, 81.5%; 423 early β-blocker therapy, 2249 controls) from 615 hospitals, 1:4 propensity score-matching created a cohort of 2110 patients (422 early β-blocker therapy, 1688 controls). There was no significant difference in 30-day in-hospital mortality between the early β-blocker group and control group (2.4% vs 2.0%, p=0.703; risk difference, 0.4%; 95% CI, −1.2% to 2.0%). Logistic regression analysis did not show a significant association between early β-blocker use and 30-day in-hospital mortality (OR, 1.17; 95% CI 0.58 to 2.37). Instrumental variable analysis also found that early β-blocker use was not associated with lower 30-day in-hospital mortality (risk difference, 1.2%; 95% CI −3.1% to 5.5%).

Conclusions This study found no significant association between early β-blocker use and in-hospital mortality in patients with TC.

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