TY - JOUR
T1 - Association of beta-blockers and first-registered heart rhythm in out-of-hospital cardiac arrest
T2 - Real-world data from population-based cohorts across two European countries
AU - ESCAPE-NET Investigators
AU - Barcella, Carlo A.
AU - Eroglu, Talip E.
AU - Hulleman, Michiel
AU - Granfeldt, Asger
AU - Souverein, Patrick C.
AU - Mohr, Grimur H.
AU - Koster, Rudolph W.
AU - Wissenberg, Mads
AU - de Boer, Anthonius
AU - Torp-Pedersen, Christian
AU - Folke, Fredrik
AU - Blom, Marieke T.
AU - Gislason, Gunnar H.
AU - Tan, Hanno L.
N1 - Funding Information: This work was supported by the European Union's Horizon 2020 research and innovation programme under the acronym ESCAPE-NET, registered under grant agreement No 733381 (C.B., T.E.E., M.T.B., and H.L.T.), and the Netherlands CardioVascular Research Initiative (Dutch Heart Foundation, Dutch Federation of University Medical Centers, Netherlands Organization for Health Research and Development, and Royal Netherlands Academy of Sciences) grant CVON-2018-30 Predict 2 (M.T.B. and H.L.T.) and CVON-2017-15 RESCUED (H.L.T.). M.H. is supported by a grant from the Netherlands Heart Foundation (2013T034). The ARREST registry is supported by Stryker (Redmond, WA, USA). The Danish Cardiac Arrest Registry is supported by Trygfonden. Publisher Copyright: © The Author(s) 2020. Published by Oxford University Press on behalf of the European Society of Cardiology.
PY - 2020/8/1
Y1 - 2020/8/1
N2 - Aims: Conflicting results have been reported regarding the effect of beta-blockers on first-registered heart rhythm in out-of-hospital cardiac arrest (OHCA). We aimed to establish whether the use of beta-blockers influences first-registered rhythm in OHCA. Methods and results: We included patients with OHCA of presumed cardiac cause from two large independent OHCA-registries from Denmark and the Netherlands. Beta-blocker use was defined as exposure to either non-selective beta-blockers, b1-selective beta-blockers, or a-b-dual-receptor blockers within 90 days prior to OHCA. We calculated odds ratios (ORs) for the association of beta-blockers with first-registered heart rhythm using multivariable logistic regression. We identified 23 834 OHCA-patients in Denmark and 1584 in the Netherlands: 7022 (29.5%) and 519 (32.8%) were treated with beta-blockers, respectively. Use of non-selective beta-blockers, but not b1-selective blockers, was more often associated with non-shockable rhythm than no use of beta-blockers [Denmark: OR 1.93, 95% confidence interval (CI) 1.48-2.52; the Netherlands: OR 2.52, 95% CI 1.15-5.49]. Non-selective beta-blocker use was associated with higher proportion of pulseless electrical activity (PEA) than of shockable rhythm (OR 2.38, 95% CI 1.01-5.65); the association with asystole was of similar magnitude, although not statistically significant compared with shockable rhythm (OR 2.34, 95% CI 0.89-6.18; data on PEA and asystole were only available in the Netherlands). Use of a-b-dual-receptor blockers was significantly associated with non-shockable rhythm in Denmark (OR 1.21; 95% CI 1.03-1.42) and not significantly in the Netherlands (OR 1.37; 95% CI 0.61-3.07). Conclusion: Non-selective beta-blockers, but not b1-selective beta-blockers, are associated with non-shockable rhythm in OHCA.
AB - Aims: Conflicting results have been reported regarding the effect of beta-blockers on first-registered heart rhythm in out-of-hospital cardiac arrest (OHCA). We aimed to establish whether the use of beta-blockers influences first-registered rhythm in OHCA. Methods and results: We included patients with OHCA of presumed cardiac cause from two large independent OHCA-registries from Denmark and the Netherlands. Beta-blocker use was defined as exposure to either non-selective beta-blockers, b1-selective beta-blockers, or a-b-dual-receptor blockers within 90 days prior to OHCA. We calculated odds ratios (ORs) for the association of beta-blockers with first-registered heart rhythm using multivariable logistic regression. We identified 23 834 OHCA-patients in Denmark and 1584 in the Netherlands: 7022 (29.5%) and 519 (32.8%) were treated with beta-blockers, respectively. Use of non-selective beta-blockers, but not b1-selective blockers, was more often associated with non-shockable rhythm than no use of beta-blockers [Denmark: OR 1.93, 95% confidence interval (CI) 1.48-2.52; the Netherlands: OR 2.52, 95% CI 1.15-5.49]. Non-selective beta-blocker use was associated with higher proportion of pulseless electrical activity (PEA) than of shockable rhythm (OR 2.38, 95% CI 1.01-5.65); the association with asystole was of similar magnitude, although not statistically significant compared with shockable rhythm (OR 2.34, 95% CI 0.89-6.18; data on PEA and asystole were only available in the Netherlands). Use of a-b-dual-receptor blockers was significantly associated with non-shockable rhythm in Denmark (OR 1.21; 95% CI 1.03-1.42) and not significantly in the Netherlands (OR 1.37; 95% CI 0.61-3.07). Conclusion: Non-selective beta-blockers, but not b1-selective beta-blockers, are associated with non-shockable rhythm in OHCA.
KW - Asystole
KW - Beta-blockers
KW - ESCAPE-NET
KW - First-registered heart rhythm
KW - Non-shockable heart rhythm
KW - Out-of-hospital cardiac arrest
KW - Pulseless electrical activity
UR - http://www.scopus.com/inward/record.url?scp=85089128042&partnerID=8YFLogxK
U2 - https://doi.org/10.1093/europace/euaa124
DO - https://doi.org/10.1093/europace/euaa124
M3 - Article
C2 - 32594166
SN - 1099-5129
VL - 22
SP - 1206
EP - 1215
JO - Europace
JF - Europace
IS - 8
ER -