Is there evidence favoring the use of beta-blockers and dobutamine in acute heart failure?

Luiz Carlos Santana Passos, Andréa Cristina Costa Barbosa, Márcio Galvão Oliveira, Edval Gomes Santos

Programa de Pós-Graduação em Medicina e Saúde, Universidade Federal da Bahia, Salvador, BA, Brasil. lcpassos@ufba.br

Arquivos brasileiros de cardiologia 2013 Feb

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Several studies have reported the benefits of beta-blockers (BB) for patients presenting with systolic heart failure. however, many patients hospitalized as a result of acute heart failure are already using BB and require dobutamine for arterial hypotension and low cardiac output. Therefore, a decision must be made regarding whether BB should be maintained or even started in such cases. The aim of this study was to establish whether there is evidence supporting the safety andyeffectiveness of BB together with dobutamine for patients presenting with acute decompensated heart failure (ADHF). We conducted a search of the English-language literature in the databases MEDLINE, ISI Web of Science, Virtual Health Library, Cochrane Library and the CAPES Portal of Scientific Journals to identify related studies. Additional literature was obtained through the review of relevant references in the identified articles. The expected outcomes included information on the prognosis (in-hospital and on follow-up mortality, number of days of hospitalization and readmission),yeffectiveness and safety (worsening of symptoms, shock, intolerance) of the concomitant use of these drugs in hospitalized patients with ADHF and low cardiac output. This review included nine studies. however, no randomized clinical trials on this subject were found. Most studies include a low number of patients, and no studies addressing the safety of the concomitant use of these drugs were found. The resulting data suggest that a careful literature review did not supply evidence for the systematic use of BB in patients with low cardiac output syndrome who require dobutamine for inotropic support.

Citation

Luiz Carlos Santana Passos, Andréa Cristina Costa Barbosa, Márcio Galvão Oliveira, Edval Gomes Santos. Is there evidence favoring the use of beta-blockers and dobutamine in acute heart failure? Arquivos brasileiros de cardiologia. 2013 Feb;100(2):190-7