Histamine H2 receptor antagonist exhibited comparable all-cause mortality-decreasing effect as -blockers in critically ill patients with heart failure: a cohort study

Background: Our previous study reported that histamine H2 receptor antagonists (H2RAs) exposure was associated with decreased mortality in critically ill patients with heart failure (HF) through the same pharmacological mechanism as beta-blockers. However, population-based clinical study directly comparing the efficacy of H2RAs and beta-blockers on mortality of HF patients are still lacking. This study aims to compare the association difference of H2RAs and beta-blockers on mortality in critically ill patients with HF using the Medical Information Mart for Intensive Care III database (MIMIC-III).Methods: Study population was divided into 4 groups: beta-blockers + H2RAs group, beta-blockers group, H2RAs group, and Non-beta-blockers + Non-H2RAs group. Kaplan-Meier curves and multivariable Cox regression models were employed to evaluate the differences of all-cause mortalities among the 4 groups. Propensity score matching (PSM) was used to increase comparability of four groups.Results: A total of 5593 patients were included. After PSM, multivariate analyses showed that patients in H2RAs group had close all-cause mortality with patients in beta-blockers group. Furthermore, 30-day, 1-year, 5-year and 10-year all-mortality of patients in beta-blockers + H2RAs group were significantly lower than those of patients in beta-blockers group, respectively (HR: 0.64, 95%CI: 0.50-0.82 for 30-day; HR: 0.80, 95%CI: 0.69-0.93 for 1-year mortality; HR: 0.83, 95%CI: 0.74-0.93 for 5-year mortality; and HR: 0.85, 95%CI: 0.76-0.94 for 10-year mortality, respectively).Conclusion: H2RAs exposure exhibited comparable all-cause mortality-decreasing effect as beta-blockers; and, furthermore, H2RAs and beta-blockers had additive or synergistic interactions to improve survival in critically ill patients with HF.