Key result
Beta-blockers in HFpEF are linked to a ~26% higher risk of major CV events.
Why the study?
Does beta-blocker use reduce cardiovascular events and mortality in patients with heart failure with preserved ejection fraction?
Observational (n=3,417)
Yes
Does beta-blocker use reduce cardiovascular events and mortality in patients with heart failure with preserved ejection fraction?
Effect estimate: HR 1.26 (95% CI 1.04-1.53)
Absolute Event Rate: 78.5% vs 58.1%
p-value: p=0.02
Beta-blocker use in patients with HFpEF, particularly those without a previous myocardial infarction, is associated with an increased risk of adverse cardiovascular events and mortality.
May increase CV events in HFpEF without prior MI; leaves open need for RCTs to confirm association.
To assess whether beta-blocker use is associated with cardiovascular events and mortality in patients with heart failure with preserved ejection fraction (HFpEF), this study analyzed the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial data using Cox proportional hazard models. Adjusted HRs for composite cardiovascular events in all patients and in patients without previous MI were significantly higher for those on beta-blockers than for those not on beta-blockers (Hazard ratio [HR] for all patients 1.23, 95% confidence interval [95% CI] 1.02-1.49; HR for patients without previous MI 1.35, 95% CI 1.08-1.70), whereas that for patients with previous MI was not significantly different (HR 1.06, 95% CI 0.74-1.54). Additionally, cardiovascular event risk in propensity score-matched patients without previous MI was significantly higher in those on beta-blockers than in those not on beta-blockers. Risks of all-cause death, major cardiovascular events, and heart failure hospitalization were significantly higher in those on beta-blockers than in those not on beta-blockers. Beta-blocker use in HFpEF patients, particularly those without previous MI, was associated with increased risk of unfavorable cardiovascular events.
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Tsujimoto et al. (2018) conducted an observational in Heart failure with preserved ejection fraction (HFpEF) (n=3,417). Beta-blockers vs. No beta-blockers was evaluated on Composite of cardiovascular death, aborted cardiac arrest, nonfatal stroke, nonfatal MI, or heart failure hospitalization (HR 1.26, 95% CI 1.04-1.53, p=0.02). Beta-blocker use in patients with heart failure with preserved ejection fraction was associated with a significantly increased risk of composite cardiovascular events compared to non-use (HR 1.26).
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