TY - JOUR
T1 - Beta-blocker use and outcomes in patients with heart failure and mildly reduced and preserved ejection fraction
AU - Matsumoto, Shingo
AU - Henderson, Alasdair D.
AU - Shen, Li
AU - Kondo, Toru
AU - Yang, Mingming
AU - Campbell, Ross T.
AU - Anand, Inder S.
AU - de Boer, Rudolf A.
AU - Desai, Akshay S.
AU - Lam, Carolyn S.P.
AU - Maggioni, Aldo P.
AU - Martinez, Felipe A.
AU - Packer, Milton
AU - Redfield, Margaret M.
AU - Rouleau, Jean L.
AU - Van Veldhuisen, Dirk J.
AU - Vaduganathan, Muthiah
AU - Zannad, Faiez
AU - Zile, Michael R.
AU - Jhund, Pardeep S.
AU - Solomon, Scott D.
AU - McMurray, John J.V.
N1 - Publisher Copyright:
© 2024 European Society of Cardiology.
PY - 2025/1
Y1 - 2025/1
N2 - Aims: In the absence of randomized trial evidence, we performed a large observational analysis of the association between beta-blocker (BB) use and clinical outcomes in patients with heart failure (HF) and mildly reduced (HFmrEF) and preserved ejection fraction (HFpEF).
Methods and results: We pooled individual patient data from four large HFmrEF/HFpEF trials (I-Preserve, TOPCAT, PARAGON-HF, and DELIVER). The primary outcome was the composite of cardiovascular death or HF hospitalization. Among the 16 951 patients included, the mean left ventricular ejection fraction (LVEF) was 56.8%, and 13 400 (79.1%) had HFpEF (LVEF ≥50%). Overall, 12 812 patients (75.6%) received a BB. The median bisoprolol-equivalent dose of BB was 5.0 (Q1–Q3: 2.5–5.0) mg with BB continuation rates of 93.1% at 2 years (in survivors). The unadjusted hazard ratio (HR) for the primary outcome did not differ between BB users and non-users (HR 0.98, 95% confidence interval [CI] 0.91–1.05), but the adjusted HR was lower in BB users than non-users (0.81, 95% CI 0.74–0.88), and this association was maintained across LVEF (pinteraction = 0.88). In subgroup analyses, the adjusted risk of the primary outcome was similar in BB users and non-users with or without a history of myocardial infarction, hypertension, or a baseline heart rate <70 bpm. By contrast, a better outcome with BB use was seen in patients with atrial fibrillation compared to those without atrial fibrillation (pintreraction = 0.02).
Conclusions: In this observational analysis of non-randomized BB treatment, there was no suggestion that BB use was associated with worse HF outcomes in HFmrEF/HFpEF, even after extensive adjustment for other prognostic variables.
AB - Aims: In the absence of randomized trial evidence, we performed a large observational analysis of the association between beta-blocker (BB) use and clinical outcomes in patients with heart failure (HF) and mildly reduced (HFmrEF) and preserved ejection fraction (HFpEF).
Methods and results: We pooled individual patient data from four large HFmrEF/HFpEF trials (I-Preserve, TOPCAT, PARAGON-HF, and DELIVER). The primary outcome was the composite of cardiovascular death or HF hospitalization. Among the 16 951 patients included, the mean left ventricular ejection fraction (LVEF) was 56.8%, and 13 400 (79.1%) had HFpEF (LVEF ≥50%). Overall, 12 812 patients (75.6%) received a BB. The median bisoprolol-equivalent dose of BB was 5.0 (Q1–Q3: 2.5–5.0) mg with BB continuation rates of 93.1% at 2 years (in survivors). The unadjusted hazard ratio (HR) for the primary outcome did not differ between BB users and non-users (HR 0.98, 95% confidence interval [CI] 0.91–1.05), but the adjusted HR was lower in BB users than non-users (0.81, 95% CI 0.74–0.88), and this association was maintained across LVEF (pinteraction = 0.88). In subgroup analyses, the adjusted risk of the primary outcome was similar in BB users and non-users with or without a history of myocardial infarction, hypertension, or a baseline heart rate <70 bpm. By contrast, a better outcome with BB use was seen in patients with atrial fibrillation compared to those without atrial fibrillation (pintreraction = 0.02).
Conclusions: In this observational analysis of non-randomized BB treatment, there was no suggestion that BB use was associated with worse HF outcomes in HFmrEF/HFpEF, even after extensive adjustment for other prognostic variables.
KW - Atrial fibrillation
KW - Beta-blocker
KW - Heart failure and mildly reduced ejection fraction
KW - Heart failure and preserved ejection fraction
UR - https://www.scopus.com/pages/publications/85202936388
U2 - 10.1002/ejhf.3383
DO - 10.1002/ejhf.3383
M3 - Article
AN - SCOPUS:85202936388
SN - 1388-9842
VL - 27
SP - 124
EP - 139
JO - European Journal of Heart Failure
JF - European Journal of Heart Failure
IS - 1
ER -