June 25, 2026Journal of the American College of Cardiology
Beta-Blockade With Nebivolol in Elderly Heart Failure Patients With Impaired and Preserved Left Ventricular Ejection Fraction
Key result
Nebivolol shows similar effects on mortality or cardiovascular hospitalizations in both HFrEF and HFpEF.
- HR 0.86 (impaired EF); HR 0.81 (preserved EF)
- 95% CI 0.72-1.04 (impaired EF); 0.63-1.04 (preserved EF)
- P=0.720 for subgroup interaction
- n=2,111
Why the study?
Beta-blockers are established in heart failure with impaired ejection fraction, but their value in preserved ejection fraction is unclear.
Population
2,111 elderly heart failure patients with impaired or preserved ejection fraction
Comparison
Nebivolol vs placebo across impaired (EF <=35%) and preserved (EF >35%) groups
Design
Pre-specified trial subanalysis
Follow-up
21 months
Authors
Discussion
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Member takes
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“There isn't that level of recommendation for beta-blockers in preserved heart failure with ejection fraction because it's not shown to improve those hard clinical outcomes in trials. In fact, we have some data that coming off of beta-blockers can help patients feel and function better.”
“It's not just an absence of evidence; it's evidence of absence. It's not that they haven't been studied. In fact, in certain patients with HFpEF, beta-blockers may worsen things.”
Implication
Nebivolol benefits elderly HF patients similarly across EF strata; extends beta-blocker evidence to preserved EF.
Key Points
- This analysis aims to evaluate the effects of nebivolol in elderly heart failure patients with impaired versus preserved left ventricular ejection fraction.
- Included 2,111 elderly heart failure patients from the SENIORS trial
- Compared outcomes in those with impaired EF (≤35%) and preserved EF (>35%)
- Follow-up duration was 21 months with primary endpoint being all-cause mortality or cardiovascular hospitalizations.
- Primary endpoint occurred in 34.2% of patients with impaired EF and 31.2% with preserved EF
- Hazard ratio for impaired EF was 0.86 (95% CI: 0.72 to 1.04) and for preserved EF 0.81 (95% CI: 0.63 to 1.04) with p=0.720 for subgroup interaction
- Effects on all secondary endpoints were similar between groups with HR of 0.84 for impaired EF and 0.91 for preserved EF.
Study Design
Type
RCT (n=2,111)
PICO
P
Population
2,111 elderly patients with heart failure (1,359 with impaired EF and 752 with preserved EF) followed for 21 months.
I
Intervention / Comparator
Nebivolol vs Placebo
O
Primary Outcome
all-cause mortality or cardiovascular hospitalizations — HR 0.86 (impaired EF); HR 0.81 (preserved EF) (0.72-1.04 (impaired EF); 0.63-1.04 (preserved EF)), p=0.720 for subgroup interaction
Main Result
Effect estimate: HR 0.86 (impaired EF); HR 0.81 (preserved EF) (95% CI 0.72-1.04 (impaired EF); 0.63-1.04 (preserved EF))
p-value: p=0.720 for subgroup interaction
Cite This Study
Veldhuisen et al. (2009) conducted an RCT in Heart failure (n=2,111). Nebivolol vs. Placebo was evaluated on all-cause mortality or cardiovascular hospitalizations (HR 0.86 (impaired EF); HR 0.81 (preserved EF), 95% CI 0.72-1.04 (impaired EF); 0.63-1.04 (preserved EF), p=0.720 for subgroup interaction). Nebivolol had a similar effect on all-cause mortality or cardiovascular hospitalizations in elderly heart failure patients with impaired (HR 0.86) and preserved (HR 0.81) ejection fraction (P=0.720 for interaction).