Why the study?
Targeted heart rate control in septic shock patients requiring vasopressor support has been proposed to improve outcomes, but evidence on drug-specific mortality effects remains inconclusive.
Do heart rate control agents reduce 28-day all-cause mortality in patients with septic shock requiring vasopressor support?
Meta-Analysis
Do heart rate control agents reduce 28-day all-cause mortality in patients with septic shock requiring vasopressor support?
Relative Risk: 0.73 (95% CI 0.56–0.95)
In patients with septic shock requiring vasopressors, heart rate control with esmolol may provide a mortality benefit, whereas landiolol and ivabradine do not show a clear advantage.
Supports esmolol-specific mortality benefit in septic shock; extends prior analyses but leaves optimal agent selection open pending head-to-head RCTs.
Background: Tachycardia in septic shock is a typical physiological response driven by sympathetic activation and vasopressor use.While initially compensatory, excessive heart rates (HRs) can compromise myocardial efficiency and lead to worse outcomes.Targeted HR control has been proposed to mitigate these effects, although the evidence remains inconclusive.Objective: To evaluate drug-specific effects of HR control agents on 28-day all-cause mortality in patients with septic shock requiring vasopressor support.Methods: A subgroup meta-analysis and meta-regression were performed using randomized controlled trials (RCTs) included in a recent systematic review.Relative risk (RR) estimates and heterogeneity (I²) were calculated using R. Subgroup analyses compared outcomes across drugs, and a meta-regression assessed the impact of Landiolol (vs non-Landiolol agents) as a binary moderator.Results: Esmolol (n = 5; 431 participants) was associated with a significant mortality benefit (RR: 0.73; 95% CI: 0.56-0.95;I² = 29.4%),whereas Landiolol (n = 3) showed insignificant effect (RR: 1.08; 95% CI: 0.45-2.62;I² = 43.2%).Meta-regression revealed a nonsignificant trend toward increased mortality with Landiolol (β = 0.42; p = 0.21).Conclusion: Esmolol appears beneficial, while Ivabradine and Landiolol show no clear mortality advantage.Further head-to-head trials are warranted.
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Khandelwal et al. (2025) conducted a meta-analysis in Septic shock requiring vasopressor support. Heart rate control agents (Esmolol, Landiolol, Ivabradine) vs. Control was evaluated on 28-day all-cause mortality (RR 0.73, 95% CI 0.56-0.95).
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