Key result
Beta-blocker discontinuation yields limited and conflicting evidence versus continuation in HFpEF or HFimpEF.
Why the study?
Beta-blockers are commonly used in HFpEF or HFimpEF, but their benefits in these populations are not clear, raising consideration of discontinuation.
Does beta-blocker discontinuation improve outcomes or physiological parameters in adults with HFpEF or HFimpEF compared to continuation?
Systematic Review
Does beta-blocker discontinuation improve outcomes or physiological parameters in adults with HFpEF or HFimpEF compared to continuation?
Current evidence on beta-blocker discontinuation in HFpEF and HFimpEF is limited and heterogeneous, though short-term functional improvements were seen in HFpEF.
Limited evidence on beta-blocker discontinuation in HFpEF/HFimpEF warrants caution against routine deprescribing; leaves open the need for definitive RCTs.
BACKGROUND: Beta-blockers are commonly used among patients with heart failure and preserved or improved ejection fraction (HFpEF or HFimpEF). The benefits of beta-blockers in these populations are not clear, which may raise consideration of discontinuation. We conducted a systematic review on the effects of beta-blocker discontinuation versus continuation among adults ≥18 years with HFpEF or HFimpEF. METHODS: We searched MEDLINE, Embase, Cochrane CENTRAL, Google Scholar, Epistemonikos, and reference lists of eligible studies from inception to September 11, 2025. Eligible studies were randomized controlled trials (RCT), quasi-randomized studies, and non-randomized studies. Outcomes were mortality, major adverse cardiovascular events (MACE), HF hospitalizations, function, quality of life, as well as cardiovascular (CV) physiological and echocardiographic parameters. We conducted a narrative synthesis. RESULTS: We screened 4103 titles/abstracts, and 4 studies were eligible (1 RCT in HFpEF, 1 RCT in HFimpEF, and 2 cohort studies in HFimpEF). In HFpEF, beta-blocker discontinuation improved functional capacity and quality-of-life at 2 weeks compared with continuation with no clear effect on cognition, echocardiographic parameters or CV biomarkers. Long-term effects of beta-blocker discontinuation, and the effect on important clinical outcomes were unclear for HFpEF. In HFimpEF, available evidence suggests beta-blocker discontinuation might not lead to significant changes in CV physiology parameters, biomarkers, echocardiographic parameters, or clinical status compared with continuation, but findings on important long-term clinical outcomes was conflicting. CONCLUSIONS: Evidence on beta-blocker discontinuation in HFpEF or HFimpEF is limited and comes from heterogenous populations/subgroups. Future RCTs examining long-term, clinical outcomes can clarify uncertainty around the benefits/harms of beta-blocker discontinuation.
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Thompson et al. (2026) conducted a systematic review in Heart failure with preserved or improved ejection fraction (HFpEF or HFimpEF). Beta-blocker discontinuation vs. Beta-blocker continuation was evaluated on Mortality, major adverse cardiovascular events (MACE), HF hospitalizations, function, quality of life, as well as cardiovascular physiological and echocardiographic parameters. A systematic review of 4 studies found limited and conflicting evidence regarding the clinical effects of beta-blocker discontinuation versus continuation in patients with HFpEF or HFimpEF.
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