TOPLINE

The postdischarge use of nonselective beta-blockers (NSBBs) among patients with viral hepatitis-related cirrhosis following hospitalization for nonbleeding decompensation events was associated with a significantly lower risk for all-cause mortality at 6 months and a modestly lower risk for hospital readmission at 3 months. Notably, this survival benefit was more pronounced with low-dose therapy and particularly with the use of carvedilol.

METHODOLOGY

• Although current guidelines recommend NSBB therapies for lowering portal hypertension and preventing esophageal variceal bleeding in patients with cirrhosis, the role of NSBBs in nonbleeding decompensation events remains unclear.
• Using a Korean database, researchers conducted an emulated target trial between 2013 and 2023 to evaluate the postdischarge effects of NSBBs on mortality and hospital readmission in 7725 patients with viral hepatitis-related cirrhosis following hospitalization for hepatic encephalopathy, hepatorenal syndrome, ascites, and/or spontaneous bacterial peritonitis.
• Among the included participants, 2455 (mean age, 57.1 years; 70.7% men) were prescribed beta-blockers at hospital discharge and 5270 (mean age, 58.7 years; 64.1% men) were not; patients with variceal bleeding were excluded.
• Exposure was defined as a discharge prescription for propranolol or carvedilol for at least 2 days. Low-dose therapy was defined as propranolol at < 40 mg/d or carvedilol at < 12.5 mg/d, and moderate- to high-dose therapy was defined as propranolol at ≥ 40 mg/d or carvedilol at ≥ 12.5 mg/d.
• The primary outcome was all-cause mortality within 6 months of discharge; the secondary outcome was all-cause hospital readmission within 3 months of discharge.

TAKEAWAY

• At 6 months, NSBB users had a significantly lower risk for all-cause mortality than nonusers (adjusted hazard ratio [aHR], 0.82; 95% CI, 0.68-0.97); however, the association was statistically significant only for non-liver-related mortality (aHR, 0.75; 95% CI, 0.57-0.99).
• NSBB use was associated with a significantly lower risk for 3-month readmission after discharge (aHR, 0.92; 95% CI, 0.84-0.99); this association was specific to liver-related readmission (aHR, 0.92; 95% CI, 0.84-0.99).
• In dose-stratified analyses, the use of low-dose NSBBs was associated with a reduced risk for both 6-month mortality (aHR, 0.75; 95% CI, 0.59-0.94) and 3-month readmission (aHR, 0.84; 95% CI, 0.74-0.96) compared with nonuse of NSBBs, whereas moderate- to high-dose therapy was not significantly associated with either outcome.
• Carvedilol users had a lower risk for mortality (aHR, 0.55; 95% CI, 0.32-0.94) than nonusers, whereas for propranolol users, the association with mortality did not reach statistical significance.

IN PRACTICE

“These findings should be regarded as supporting the safety of continuing beta-blocker therapy in carefully selected patients without hemodynamic instability rather than as definitive evidence for broad initiation in this setting,” the authors of the study wrote.

SOURCE

The study was led by Byeong Geun Song, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea. It was published online in Alimentary Pharmacology & Therapeutics.

LIMITATIONS

The observational design of the study could not eliminate residual confounding from unmeasured disease severity factors. The study assumed, but did not verify, postdischarge adherence to beta-blocker therapy among the study participants. Findings were limited to patients with viral hepatitis-related cirrhosis who had survived a nonbleeding decompensating event and had no major contraindications to beta-blocker therapy.

DISCLOSURES

The study received support from the Korea National Institute of Health. The authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.