The Association of Metoprolol Use With Outcomes in Heart Failure With Preserved Ejection Fraction (HFpEF): A Propensity Score-Matched Cohort Study

This cohort study investigates the comparative health outcomes of patients with heart failure with preserved ejection fraction (HFpEF) treated with and without metoprolol, a commonly prescribed betablocker.Utilizing data from the TriNetX US Collaborative Network comprising 70 healthcare organizations, the study defines two propensity score-matched cohorts: HFpEF patients without metoprolol and those receiving metoprolol, excluding individuals with atrial fibrillation.Key outcomes assessed include mortality, HF exacerbation, and incidence of chronic kidney disease (CKD).Statistical analyses, including risk ratios (RRs) and Kaplan-Meier survival estimates, were employed to evaluate differences between cohorts.All RRS are reported for the non-metoprolol cohort (Cohort 1) relative to the metoprolol cohort (Cohort 2, reference group), so that an RR below 1.00 denotes a lower risk of the outcome in patients not treated with metoprolol, and all absolute risk differences (ARDs) are calculated as the event rate in the metoprolol cohort minus the event rate in the non-metoprolol cohort.The results demonstrate that HFpEF patients not treated with metoprolol had comparatively lower risks of mortality (15.51% vs. 18.54%;ARD: 3.03%; RR: 0.886, 95% confidence interval (CI) 0.868-0.903),HF exacerbations (6.76% vs. 8.90%; ARD: 2.14%; RR: 0.79, 95% CI: 0.765-0.815),and CKD (11.80% vs. 14.49%;ARD: 2.69%; RR: 0.838, 95% CI: 0.816-0.861)compared to those receiving metoprolol.Survival analysis further supports this association, indicating significantly higher survival probabilities in the non-metoprolol cohort.These findings suggest that metoprolol was associated with increased mortality in HFpEF patients.There may be some increased risk in HFpEF patients; however, given the retrospective observational design of the study, these findings indicate an association rather than a causal relationship, and residual confounding cannot be ruled out.Further randomized controlled trials are needed to clarify the effects of metoprolol and optimize management strategies for this complex patient population.