Association of beta-blockers and first-registered heart rhythm in out-of-hospital cardiac arrest: real-world data from population-based cohorts across two European countries

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  • Carlo A. Barcella, University of Copenhagen
  • ,
  • Talip E. Eroglu, University of Amsterdam
  • ,
  • Michiel Hulleman, University of Amsterdam
  • ,
  • Asger Granfeldt
  • Patrick C. Souverein, Utrecht University
  • ,
  • Grimur H. Mohr, University of Copenhagen
  • ,
  • Rudolph W. Koster, University of Amsterdam
  • ,
  • Mads Wissenberg, University of Copenhagen
  • ,
  • Anthonius de Boer, Utrecht University
  • ,
  • Christian Torp-Pedersen, Aalborg University, University of Copenhagen
  • ,
  • Fredrik Folke, University of Copenhagen
  • ,
  • Marieke T. Blom, University of Amsterdam
  • ,
  • Gunnar H. Gislason, University of Copenhagen, Danish Heart Foundation
  • ,
  • Hanno L. Tan, University of Amsterdam, Netherlands Heart Institute
  • ,
  • ESCAPE-NET Investigators

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, β1-selective beta-blockers, or α-β-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 β1-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 α-β-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 β1-selective beta-blockers, are associated with non-shockable rhythm in OHCA.

Original languageEnglish
Pages (from-to)1206-1215
Number of pages10
Publication statusPublished - Aug 2020

    Research areas

  • Asystole, Beta-blockers, ESCAPE-NET, First-registered heart rhythm, Non-shockable heart rhythm, Out-of-hospital cardiac arrest, Pulseless electrical activity

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