Of 22,208 patients, 3748 were hospitalized with septic shock and received chronic β-blockers (mean age 67 ± 14 years, 56% male, 87% White, median SOFA score 9.0 (IQR: 6.0–11.0) (Fig. 1A). Of those who received chronic therapy, 405 (11%) continued, 2,025 (54%) held, and 1,317 (35%) discontinued chronic β-blocker therapy during intensive care. Patients in whom β-blockers were discontinued presented with greater SOFA score (“continued,” median SOFA 8.0 (IQR: 6.0–11.0); “held,” 8.0 (IQR: 6.0–11.0; “discontinued,” 10.0 (IQR: 7.0–12.0); p < 0.001), while first-measured biomarkers, such as serum lactate, troponin, and platelets, were similar across groups.

Patient characteristics and prescribing patterns. A Patient characteristics of adults with septic shock who received chronic β-blocker therapy prior to hospitalization. Abbreviations include: d, days; ICU, intensive care unit; INR, international normalized ratio; IQR, interquartile range; no, number; SD, standard deviation; SIRS, systemic inflammatory response syndrome; SOFA, sequential organ failure assessment; y, years. SI conversion factors: To convert serum creatinine to micromole per liter, multiply by 88.4; platelet count to × 10^9/L, multiply by 1.0; and total bilirubin to micromoles per liter, multiply by 17.104. aDerived from UPMC registration system data using fixed categories similar to the Centers for Medicare & Medicaid Services electronic health record meaningful use data set. “Other” includes Chinese, Filipino, Hawaiian, American Indian/Alaskan Native, Asian, Hawaiian/other Pacific Islander, Middle Eastern, Native American, not specified, or Pacific Islander. bA method of categorizing comorbidities of patients based on the International Classification of Diseases, Ninth Revision diagnosis codes found in administrative data. Scores range from 0 to 31. cA measure of acute organ dysfunction, assessed across 6 organs, with scores ranging from 0 to 24, maximum score reached within 6 h of sepsis episode. dA measure of systemic inflammation, ranging from 0 to 4, maximum score reached within 6 h of sepsis episode. eFor 43 of 3,119 patient days (1.4%), beta blocker data was missing. fAt any time during hospitalization. gMissing 5-year mortality for remaining patients. B Heatmap of variable inpatient prescribing among 100 randomly selected patients by hospital day

Among 33,384 total patient-days, 12,613 (38%) had β-blockers alone, 9317 (28%) vasopressors alone, 2085 (6%) both vasopressors and β-blockers, and 9369 (28%) neither (Fig. 1B). During hospitalization, 92% of patients with β-blockers held restarted therapy, and the median time to restart from admission was 4 days (IQR: 2–6 days).

In-hospital mortality was highest if β-blockers were discontinued (“continued”, 17%; “held”, 16%; “discontinued”, 41%; p < 0.001). Among 1,908 patients who survived 6 months after septic shock, 89% were administered outpatient β-blockers, most often those with inpatient β-blockers continued (95%) or held (94%) versus discontinued (74%; p < 0.001).