Comparison of the Beneficial Effect of Beta-Blockers on Mortality in Patients with Ischaemic or Non-Ischaemic Systolic Heart Failure: A Meta-Analysis of Randomised Controlled Trials

UNLABELLED: Mechanisms by which beta-blockers bring benefit may differ according to the aetiology of heart failure (HF). It is uncertain whether the magnitude of the benefit of beta-blockers is the same in ischaemic or non-ischaemic HF. METHODS: We performed a systematic review of all randomised, placebo-controlled, parallel-design trials of beta-blockers in HF that collected data on mortality during follow-up. RESULTS: Among 26 randomised trials comparing beta-blockers with placebo in HF, 4 studies with 7250 patients provided information on the number of patients who died during follow-up in subgroups of ischaemic and non-ischaemic aetiology of HF. Two studies were performed with bisoprolol, one with carvedilol and one with metoprolol. HF was associated with ischaemic aetiology in 4746/7250 patients (65%) and non-ischaemic aetiology in 2504/7250 patients (35%). Mortality occurred in 301 patients. The risk ratio (RR) for beta-blockers versus placebo was 0.62 (95% confidence interval CI 0.52-0.75, p<0.00001) in ischaemic HF, compared with a RR of 0.62 (95% CI 0.45-0.84, p=0.002) in the presence of non-ischaemic HF. CONCLUSION: The magnitude of the prognostic benefit conferred by beta-blockers for overall mortality in non-ischaemic HF appears to be very similar to that in ischaemic HF.