Presence and Development of Atrial Fibrillation in Chronic Heart Failure
Why the study?
Does metoprolol CR/XL reduce mortality and prevent new-onset atrial fibrillation in patients with chronic heart failure?
Population
Patients with chronic heart failure from the MERIT-HF trial
Comparison
Metoprolol CR/XL vs Placebo
Design
RCT
Authors
Discussion
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Member takes
Implication
Supports metoprolol CR/XL to prevent new AF in chronic HF with sinus rhythm; extends RCT evidence for beta-blockers beyond mortality.
Key Points
- To evaluate the impact of metoprolol CR/XL on mortality in heart failure patients with existing atrial fibrillation and determine whether it prevents new-onset atrial fibrillation.
- Retrospective analysis of baseline electrocardiograms in the randomized MERIT-HF trial to classify baseline cardiac rhythm.
- Patients received either metoprolol CR/XL or placebo to assess total mortality and the emergence of new-onset atrial fibrillation during follow-up.
- At baseline, 556 patients (13.9%) had atrial fibrillation; mortality occurred in 30 patients on metoprolol versus 31 on placebo (RR 1.0; 95% CI 0.61–1.65).
- Among patients in sinus rhythm at baseline, new-onset atrial fibrillation developed in 47 patients on metoprolol versus 85 on placebo (RR 0.53; 95% CI 0.37–0.76; p=0.0005).
Structured PICO
Does metoprolol CR/XL reduce mortality and prevent new-onset atrial fibrillation in patients with chronic heart failure?
P
Population
Patients with chronic heart failure from the MERIT-HF trial
I
Intervention
Metoprolol CR/XL
C
Comparator
Placebo
O
Outcome
Mortality in patients with baseline atrial fibrillation and occurrence of new atrial fibrillation during follow-up in patients with baseline sinus rhythmhard clinical
In patients with chronic heart failure and sinus rhythm, metoprolol CR/XL significantly reduces the incidence of new-onset atrial fibrillation.
Limitations
- Wide confidence interval making it impossible to detect an interaction between metoprolol and mortality in patients with atrial fibrillation and heart failure
- Risk of over-interpreting effects in subgroups
Cite This Study
Veldhuisen et al. (2006) studied this question.