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

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.