Continuing home beta-blockers during suspected infection was linked to lower 90-day mortality

Design

Retrospective single-centre cohort, target trial emulation with inverse probability weighting

Population

4,635 adults on home beta-blockers admitted from the ED with suspected infection, without shock

Primary outcome

90-day all-cause mortality

Effect

HR 0.77 (95% CI 0.61-0.98)

This single-centre US study, published in June 2026, emulated a trial of continuing or stopping oral beta-blockers within 48 hours of admission from the emergency department with suspected infection. Patients in shock, with heart rates below 40 or above 120, or needing intravenous rate control were excluded.

Of 4,635 eligible patients, only a quarter had their beta-blocker continued. Continuation was associated with lower 90-day mortality (HR 0.77, 95% CI 0.61 to 0.98) and shorter stay. In-hospital mortality did not differ significantly (OR 0.60, 0.30 to 1.20).

Clinicians probably stopped beta-blockers in patients who looked sicker, and weighting can only partly correct for that. The finding challenges reflex discontinuation in stable patients, but it is not trial evidence.

• Do not stop a home beta-blocker by reflex in a haemodynamically stable patient admitted with infection.
• Hold it when there is hypotension, shock, bradycardia or high-grade heart block.
• Document the decision and the reason, so the ward team knows when to restart.
• Restart promptly once the patient is stable, particularly after myocardial infarction or in heart failure.

Why it matters

Three-quarters had their beta-blocker stopped, and this suggests that default may not be harmless.

Don't overread it

Sicker patients were more likely to have beta-blockers stopped, which could explain part of the difference.

The statistics, in plain English

A hazard ratio of 0.77 means deaths by 90 days occurred at about three-quarters the rate when beta-blockers were continued. The interval only just excludes no effect, and the in-hospital result was not significant.

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