Effects of left ventricular ejection fraction on outcomes similar in elderly patients with HF regardless of beta-blocker cascade

Issue: August 2009

The effects of nebivolol in elderly patients with HF were similar in the setting of both preserved and impaired ejection fraction.

The subgroup analysis examined 2,111patients from the SENIORS trial who had either impaired ejection fraction of =35% (n=1,359) or preserved ejection fraction of >35% (n=752). There were 678 patients assigned to nebivolol (Bystolic, Forest Labs) and 681 assigned to placebo in the impaired ejection fraction group, and there were 380 patients assigned to nebivolol and 372 assigned to placebo in the preserved ejection fraction group. The primary outcome for the trial was all-cause mortality or CV hospitalization.

According to the researchers, there was no difference in the effect of nebivolol vs. placebo between the preserved and impaired ejection fraction groups (P=.72 for subgroup interaction). The primary outcome occurred in 465 patients (34.2%) with impaired ejection fraction and 235 patients (31.2%) with preserved ejection fraction. The hazard ratio for nebivolol vs. placebo in the impaired ejection fraction group was 0.86 (95% CI, 0.72-1.04), and was 0.81 (95% CI, 0.63-1.04) in the preserved ejection fraction group. No differences in interaction for the secondary endpoints were reported.

“This finding is particularly important for patients with preserved ejection fraction because no (pharmacologic) treatment has yet been shown to improve the outcome in this population,” the researchers concluded. “Some positive data for ACE inhibitors and angiotensin receptor-blockers are available in these patients, the but the current study provides the first large-scale data for a potentially beneficial effect of beta-blockade in HF patients with preserved ejection fraction, and is the only one in elderly HF patients.”

For more information:

Van Veldhuisen D. J Am Coll Cardiol. 2009;53:2150-2158.