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Background <p>Tachycardia is common in sepsis and is associated with poor outcomes. β-blockers have been used for heart rate (HR) control, but comparative evidence between short- and long-acting agents remains limited. The aim of this study was to compare the efficacy and safety of intravenous landiolol and a bisoprolol transdermal patch in patients with sepsis-related tachycardia.</p> Methods <p>This multicenter retrospective cohort study included adult patients with sepsis-related tachycardia (HR ≥ 100&#xa0;bpm) treated with landiolol or a bisoprolol transdermal patch at intensive care units (ICUs) participating in a Japanese ICU database, from January 2014 to March 2026. Propensity score matching (PSM) at a 1:1 ratio was performed to adjust for baseline differences between groups. The primary outcome was the proportion of patients who achieved HR control (60–94&#xa0;bpm) at 24&#xa0;h. The secondary outcomes included in-hospital mortality, bradycardia incidence, the proportion requiring increased norepinephrine-equivalent doses at 24&#xa0;h, and trends in HR and mean arterial pressure (MAP) over 24&#xa0;h.</p> Results <p>After PSM, data from 950 patients were analyzed (n = 475 in each group). HR control at 24&#xa0;h did not differ between the two groups (landiolol: 56% vs. bisoprolol: 54%, <i>p</i> = 0.561) in overall sepsis patients. In the subgroup of patients with septic shock, HR control at 24&#xa0;h was achieved more frequently with landiolol than with bisoprolol (65 vs. 53%; p = 0.046). In-hospital mortality was 5.1% in the landiolol group and 8.0% in the bisoprolol group (p = 0.088). Bradycardia incidence (3.8 vs. 5.9%, p = 0.174) and the proportion of patients requiring increased norepinephrine-equivalent doses at 24&#xa0;h (16 vs. 13%, p = 0.170) were comparable between the two groups. Landiolol achieved a more rapid HR reduction, whereas bisoprolol induced a moderate decrease in HR.</p> Conclusions <p>Landiolol and the bisoprolol transdermal patch achieved comparable 24-h HR control in the overall cohort of sepsis patients with tachycardia. A higher rate of HR control with landiolol was observed in patients with septic shock. The effect of these agents on mortality remains unclear, and further studies are warranted.</p>

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Comparative efficacy of landiolol and bisoprolol transdermal patch in patients with sepsis-related tachycardia: a retrospective cohort study

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  • 发表日期：

    2026年8月5日

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  • Shuhei Murao,
  • Jumpei Yoshimura,
  • Yutaka Umemura,
  • Jun Oda,
  • Satoshi Fujimi

摘要

Background

Tachycardia is common in sepsis and is associated with poor outcomes. β-blockers have been used for heart rate (HR) control, but comparative evidence between short- and long-acting agents remains limited. The aim of this study was to compare the efficacy and safety of intravenous landiolol and a bisoprolol transdermal patch in patients with sepsis-related tachycardia.

Methods

This multicenter retrospective cohort study included adult patients with sepsis-related tachycardia (HR ≥ 100 bpm) treated with landiolol or a bisoprolol transdermal patch at intensive care units (ICUs) participating in a Japanese ICU database, from January 2014 to March 2026. Propensity score matching (PSM) at a 1:1 ratio was performed to adjust for baseline differences between groups. The primary outcome was the proportion of patients who achieved HR control (60–94 bpm) at 24 h. The secondary outcomes included in-hospital mortality, bradycardia incidence, the proportion requiring increased norepinephrine-equivalent doses at 24 h, and trends in HR and mean arterial pressure (MAP) over 24 h.

Results

After PSM, data from 950 patients were analyzed (n = 475 in each group). HR control at 24 h did not differ between the two groups (landiolol: 56% vs. bisoprolol: 54%, p = 0.561) in overall sepsis patients. In the subgroup of patients with septic shock, HR control at 24 h was achieved more frequently with landiolol than with bisoprolol (65 vs. 53%; p = 0.046). In-hospital mortality was 5.1% in the landiolol group and 8.0% in the bisoprolol group (p = 0.088). Bradycardia incidence (3.8 vs. 5.9%, p = 0.174) and the proportion of patients requiring increased norepinephrine-equivalent doses at 24 h (16 vs. 13%, p = 0.170) were comparable between the two groups. Landiolol achieved a more rapid HR reduction, whereas bisoprolol induced a moderate decrease in HR.

Conclusions

Landiolol and the bisoprolol transdermal patch achieved comparable 24-h HR control in the overall cohort of sepsis patients with tachycardia. A higher rate of HR control with landiolol was observed in patients with septic shock. The effect of these agents on mortality remains unclear, and further studies are warranted.