Why the study?
Evidence regarding the effectiveness of β-blockers in heart failure and atrial fibrillation in a contemporary cohort remains controversial.
Does β-blocker use reduce the composite outcome of all-cause mortality or HF rehospitalization in hospitalized HF patients with and without AF?
Does β-blocker use reduce the composite outcome of all-cause mortality or HF rehospitalization in hospitalized HF patients with and without AF?
β-blocker use is associated with a small but significant reduction in all-cause mortality or HF rehospitalization in patients with heart failure, regardless of the presence of atrial fibrillation, even in a superaged population.
β-blocker use was associated with modestly lower risk in elderly HF patients regardless of AF; extends observational data but leaves open need for randomized confirmation.
Evidence of the effectiveness of β-blockers in heart failure (HF) and atrial fibrillation (AF) in a contemporary cohort is controversial. This study investigated the association between the use of β-blockers and prognosis in hospitalized HF patients with and without AF in Japan. Patients hospitalized with the first episode of acute HF were identified from the National Database of Health Insurance Claims and Specific Health Checkups of Japan between April 2014 and March 2021. Associations of β-blocker use and prognosis were compared by propensity score matching among the AF or non-AF group. A mixed-effects survival model was used, and hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated. Among 428,650 patients discharged with HF in 4,433 hospitals, 175,174 (40.9%) were ≥ 85 years old, 151,873 (35.4%) had complicated AF, and 236,457 (55.2%) were β-blocker users. In a matched AF group, β-blocker use was associated with a lower composite outcome of all-cause mortality or HF rehospitalization (HR [95% CI], 0.95 [0.93-0.97]). A similar result was obtained in a matched non-AF group (0.95 [0.94-0.96]). In addition, the HRs in patients aged ≥ 85 years and female patients were 1.00 [0.98-1.02] and 1.01 [0.98-1.03] in the AF group and 1.03 [1.01-1.05] and 0.98 [0.97-1.00] in the non-AF group, respectively. The favorable prognostic associations of β-blocker use were observed regardless of AF in patients across a broad spectrum of HF in a superaged society.
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Nakai et al. (2024) studied this question.
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