Beta-blockers in post-myocardial infarction with preserved ejection fraction: systematic review and meta-analysis

Figure 1. PRISMA flowchart.

Figure 2. ROBINS-I of non-randomized studies included in meta-analysis. (A) Summary plot of ROBINS-I. (B) Summary plot of RoB2. RoB2, risk-of-bias tool for randomized trials; ROBINS-I, risk of bias in non-randomized studies of interventions.

Figure 3. ROBINS-I of non randomized studies included in meta-analysis. D1: risk of bias due to confounding; D2: risk of bias in classification of interventions; D3: risk of bias in selection of participants into the study (or into the analysis); D4: risk of bias due to deviations from intended interventions; D5: risk of bias due to missing data; D6: risk of bias arising from measurement of the outcome; D7: risk of bias in selection of the reported result. ROBINS-I, risk of bias in non-randomized studies of interventions.

Figure 4. The risk of bias analysis of the included randomized clinical trial was performed using the RoB2 tool. D1: bias arising from the randomization process; D2: bias due to deviations from intended intervention; D3: bias due to missing outcome data; D4: bias in measurement of the outcome; D5: bias in selection of the reported result. RoB2, risk-of-bias tool for randomized trials.

Figure 5. Forest plot of all-cause mortality. (A) Comparison of all-cause mortality in BB users vs. non-users across all studies. (B) Forest plot of all-cause mortality in BB users vs. non-users, filtered by studies employing PSM methodology to adjust for baseline confounders. (C) Sensitivity analysis excluding studies with a high risk of bias. The HRs with 95% CIs are shown for each study and the overall pooled analysis. Sensitivity analysis excludes studies with high risk of bias. A: risk of bias due to confounding; B: risk of bias arising from measurement of the exposure; C: risk of bias in selections of participants into the study (or into the analysis); D: risk of bias due to post-exposure interventions; E: risk of bias due to missing data; F: risk of bias arising from measure of the outcome; G: risk of bias in selection of the reported result. BB, beta-blocker; CI, confidence interval; HR, hazard ratio; PSM, propensity score matching; SE, standard error.

Figure 6. Forest plot of cardiac mortality. (A) Cardiac mortality in BB users vs. non-users. (B) Subgroup analysis by propensity score matching. (C) Sensitivity analysis with adjusted models. Sensitivity analysis excludes studies with high risk of bias. This figure highlights the heterogeneity (I2 values) observed across the included studies. A: risk of bias due to confounding; B: risk of bias arising from measurement of the exposure; C: risk of bias in selections of participants into the study (or into the analysis); D: risk of bias due to post-exposure interventions; E: risk of bias due to missing data; F: risk of bias arising from measure of the outcome; G: risk of bias in selection of the reported result. BB, beta-blocker; CI, confidence interval; HR, hazard ratio; SE, standard error.

Figure 7. Forest plot of MACE. The pooled analysis of MACEs comparing BB users vs. non-users. The analysis includes HRs with 95% CIs for each study and the overall pooled result. The heterogeneity (I2) is indicated for all included studies. BB, beta-blocker; CI, confidence interval; HR, hazard ratio; MACE, major adverse cardiac event; SE, standard error.

Figure 8. Forest plot of reinfarction. (A) Comparison of reinfarction rates in BB users vs. non-users across included studies. (B) Subgroup analysis filtered by studies employing PSM. The figure highlights the effect estimates and heterogeneity between studies. BB, beta-blocker; CI, confidence interval; HR, hazard ratio; PSM, propensity score matching; SE, standard error.

Figure 9. Forest plot of hospitalization for HF. (A) Pooled analysis of hospitalization rates for HF in BB users vs. non-users. (B) Subgroup analysis restricted to studies with matched cohorts. The HRs and corresponding 95% CIs are displayed for each study and overall results. BB, beta-blocker; CI, confidence interval; HF, heart failure; HR, hazard ratio; PSM, propensity score matching; SE, standard error.

Figure 10. Forest plot of stroke incidence. The pooled analysis of stroke incidence in BB users vs. non-users. The analysis highlights significant heterogeneity and includes individual study estimates and the overall pooled effect. BB, beta-blocker; CI, confidence interval; HR, hazard ratio; PSM, propensity score matching; SE, standard error.