{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,12]],"date-time":"2026-11-12T11:53:49Z","timestamp":1794484429245,"version":"4.9.1"},"reference-count":34,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"9","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,9]]},"abstract":"\n OBJECTIVE:<\/jats:title>\n Beta-blockers are commonly prescribed for chronic cardiovascular diseases. Despite potential benefits in septic shock, beta-blockers are often held at hospital admission for patients with suspected infection and possible sepsis. We compared the effects of chronic beta-blocker continuation vs. discontinuation on 90-day all-cause mortality among patients admitted from the emergency department with suspected infection.<\/jats:p>\n <\/jats:sec>\n \n DESIGN:<\/jats:title>\n Retrospective cohort study using the target trial emulation framework. We used Cox regression to compare 90-day mortality between treatment groups, with inverse probability of treatment weights to account for baseline differences in sex, race, ethnicity, age, body mass index, presence of a \u201cdo not resuscitate\u201d order, comorbidities, and acute illness severity.<\/jats:p>\n <\/jats:sec>\n \n SETTING:<\/jats:title>\n A single large, academic, tertiary care emergency department in the Midwest United States.<\/jats:p>\n <\/jats:sec>\n \n PATIENTS:<\/jats:title>\n Patients 18 years or older on beta-blockers prior to admission hospitalized for suspected infection (defined by orders for blood cultures and broad-spectrum antibiotics). Patients with shock, heart rates less than 40 or greater than 120, or who required an IV beta- or calcium channel blocker at a clinician\u2019s discretion were excluded.<\/jats:p>\n <\/jats:sec>\n \n INTERVENTIONS:<\/jats:title>\n Continuation of oral beta-blockers within 48 hours of admission vs. no continuation.<\/jats:p>\n <\/jats:sec>\n \n MEASUREMENTS AND MAIN RESULTS:<\/jats:title>\n \n Of 4635 eligible patients, 1172 (25.3%) received an oral beta-blocker, whereas 3463 (74.7%) did not receive an oral beta-blocker. Beta-blocker continuation was associated with a reduced risk of all-cause mortality within 90 days of hospital admission (hazard ratio 0.77; 95% CI, 0.61\u20130.98;\n p<\/jats:italic>\n = 0.03) and shorter hospital stay (incidence rate ratio 0.39; 95% CI, 0.38\u20130.41;\n p<\/jats:italic>\n < 0.001). There was no significant association between beta-blocker continuation and in-hospital mortality (odds ratio 0.60; 95% CI, 0.30\u20131.20;\n p<\/jats:italic>\n = 0.15).\n <\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS:<\/jats:title>\n Continuation of chronic beta-blockers in a broad population of patients admitted with suspected infection was associated with improved clinical outcomes. Our findings support the need for controlled experimental studies evaluating the role of chronic beta-blocker continuation among patients hospitalized with possible sepsis.<\/jats:p>\n <\/jats:sec>","DOI":"10.1097\/ccm.0000000000007229","type":"journal-article","created":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T15:26:43Z","timestamp":1781018803000},"page":"2350-2360","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Continuing vs. Withholding Home Beta-Blockers at Admission for Suspected Infection: A Target Trial Emulation"],"prefix":"10.1097","volume":"54","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6222-9415","authenticated-orcid":false,"given":"Nathaniel","family":"Christian-Miller","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, University of Michigan, Ann Arbor, MI."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathleen Tiffany","family":"Lee","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raymond","family":"Pashun","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kareem","family":"Ballut","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hallie","family":"Prescott","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI."},{"name":"VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Cascino","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie P.","family":"Taylor","sequence":"additional","affiliation":[{"name":"Division of Hospital Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sardar","family":"Ansari","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, Ann Arbor, MI."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael W.","family":"Sjoding","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Michigan, Ann Arbor, MI."},{"name":"Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI."},{"name":"Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Max","family":"Nagle","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7432-3764","authenticated-orcid":false,"given":"Andrew J.","family":"Admon","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI."},{"name":"VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, 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