Key result
Discharge bisoprolol is linked to ~31% lower 5-year CV mortality versus less selective beta-blockers.
Why the study?
Beta-blockers beneficial in chronic HF vary considerably in cardioselectivity, and whether the cardioselectivity of beta-blockers prescribed at discharge from hospitalization for decompensated HF affects long-term prognosis was uncertain.
Does prescribing a highly cardioselective beta-blocker (bisoprolol) at discharge reduce 5-year cardiovascular mortality compared with less cardioselective or alpha-blocking beta-blockers in patients hospitalized for acute decompensated heart failure?
Cohort (n=4,053)
No
Does prescribing a highly cardioselective beta-blocker (bisoprolol) at discharge reduce 5-year cardiovascular mortality compared with less cardioselective or alpha-blocking beta-blockers in patients hospitalized for acute decompensated heart failure?
In patients discharged after acute decompensated heart failure (especially HFrEF), prescribing highly beta-1-selective bisoprolol was associated with significantly lower 5-year cardiovascular mortality compared with metoprolol or carvedilol, suggesting beta-blocker cardioselectivity may impact long-term prognosis beyond a uniform class effect.
Answers are grounded in this paper and cite their sources.
Bisoprolol at discharge was associated with lower 5-year CV mortality in decompensated HF; hypothesis-generating for cardioselectivity benefit, requiring randomized confirmation.
Background Beta-blockers (BBs) show considerable variation in cardioselectivity (i.e., the relative affinity to the β 1 receptor), even among those with evidence of benefit in the treatment of chronic heart failure (HF). We aimed to evaluate whether the cardioselectivity of BBs prescribed at discharge from hospitalization for decompensated HF will affect the long-term prognosis of patients. Methods In the prospective study, we followed 4053 patients hospitalized for decompesated HF. The entire cohort was divided into subgroups based on the cardioselectivity of the BBs prescribed at discharge. Results After complex adjustment, patients treated with a highly selective BBs (bisoprolol) showed significantly lower five-year cardiovascular mortality than those with a lesser degree of cardioselectivity (mainly metoprolol) [HRR 0.69 (95%CIs:0.52–0.92), p = 0.011]. This difference remained in patients with HF with reduced ejection fraction (HFrEF) [HRR 0.58 (95%CIs:0.37–0.89), p = 0.013], but was not yet significant in HF with preserved ejection fraction [HRR 0.66 (95%CIs:0.43–1.02), p = 0.063]. In HFrEF patients only, highly cardioselective BBs also showed a lower risk of cardiovascular mortality than nonselective BBs with α-blocking activity (mainly carvedilol) [HRR 0.55 (95%CIs:0.33–0.93, p = 0.025]. Conclusion The choice of a beta-blocker regarding the degree of its cardioselectivity may have a prognostic impact in chronic HF patients.
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Mayer et al. (2026) conducted a cohort in Chronic heart failure hospitalized for acute decompensation (n=4,053). Highly cardioselective beta-blocker (bisoprolol) prescribed at discharge vs. Moderately cardioselective beta-blockers (mainly metoprolol) or nonselective beta-blockers with alpha-blocking activity (mainly carvedilol) was evaluated on Five-year cardiovascular mortality (HR 0.69, 95% CI 0.52-0.92, p=0.011). Highly cardioselective beta-blocker (bisoprolol) at discharge was associated with lower 5-year cardiovascular mortality compared to less selective agents (HR 0.69, 95% CI 0.52-0.92, p=0.011).
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