Beta-blocker use in patients with mildly reduced or preserved ejection fraction was associated with a lower adjusted risk of cardiovascular death or heart failure hospitalization (adjusted HR 0.81; 95% CI 0.74-0.88).
Observational (n=16,951)
Yes
Does beta-blocker use reduce the composite of cardiovascular death or HF hospitalization in patients with HFmrEF and HFpEF?
In a large pooled observational analysis of patients with HFmrEF and HFpEF, beta-blocker use was associated with a lower adjusted risk of cardiovascular death or heart failure hospitalization, suggesting no harm and potential benefit.
Effect estimate: Adjusted HR 0.81 (95% CI 0.74-0.88)
ABSTRACT Aims In the absence of randomized trial evidence, we performed a large observational analysis of the association between beta-blocker (BB) use and clinical outcomes in patients with heart failure (HF) and mildly reduced (HFmrEF) and preserved ejection fraction (HFpEF). Methods and results We pooled individual patient data from four large HFmrEF/HFpEF trials (I-Preserve, TOPCAT, PARAGON-HF, and DELIVER). The primary outcome was the composite of cardiovascular death or HF hospitalization. Among the 16 951 patients included, the mean left ventricular ejection fraction (LVEF) was 56.8%, and 13 400 (79.1%) had HFpEF (LVEF ≥50%). Overall, 12 812 patients (75.6%) received a BB. The median bisoprolol-equivalent dose of BB was 5.0 (Q1–Q3: 2.5–5.0) mg with BB continuation rates of 93.1% at 2 years (in survivors). The unadjusted hazard ratio (HR) for the primary outcome did not differ between BB users and non-users (HR 0.98, 95% confidence interval CI 0.91–1.05), but the adjusted HR was lower in BB users than non-users (0.81, 95% CI 0.74–0.88), and this association was maintained across LVEF (pinteraction = 0.88). In subgroup analyses, the adjusted risk of the primary outcome was similar in BB users and non-users with or without a history of myocardial infarction, hypertension, or a baseline heart rate 70 bpm. By contrast, a better outcome with BB use was seen in patients with atrial fibrillation compared to those without atrial fibrillation (pintreraction = 0.02). Conclusions In this observational analysis of non-randomized BB treatment, there was no suggestion that BB use was associated with worse HF outcomes in HFmrEF/HFpEF, even after extensive adjustment for other prognostic variables.
Matsumoto et al. (Sat,) conducted a observational in Heart failure with mildly reduced and preserved ejection fraction (n=16,951). Beta-blocker vs. No beta-blocker was evaluated on Composite of cardiovascular death or HF hospitalization (Adjusted HR 0.81, 95% CI 0.74-0.88). Beta-blocker use in patients with mildly reduced or preserved ejection fraction was associated with a lower adjusted risk of cardiovascular death or heart failure hospitalization (adjusted HR 0.81; 95% CI 0.74-0.88).