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Patient survival with beta-blockers varies in US vs. rest of the world
O’Connor C. J Am Coll Cardiol. 2011;58:915-922.
A meta-analysis of randomized trials evaluating beta-blockers in patients with HF has reported that among those in the United States, beta-blockade correlated with a lower survival benefit compared with those in the rest of the world.
The analysis included 8,988 patients with HF (46.7% from the US) enrolled in the COPERNICUS, MERIT-HF and BEST randomized, double blind, placebo-controlled trials.
According to results, the reduction in RR for each beta-blocker among those in the US cohort was minimal and no longer significant when compared with the overall cohort, whereas those in the rest of the world experienced a mortality benefit with beta-blockade.
In a pooled analysis that also included patients from the CIBIS-II trial (n=11,635), patients taking beta-blockers had an overall RR of death of 0.77 (95% CI, 0.71-0.84) vs. placebo. Only those in the rest of the world cohort, however, had a statistically significant survival benefit with beta-blockers (RR=0.64; 95% CI, 0.56-0.72).
Postulating on the reasons behind this discrepancy, the researchers said geographic difference in treatment response may be due to differences in populations, genetic factors, cultural or social differences in disease management, or low power and statistical chance.
“Whatever the cause, geographic differences are reported frequently in the literature, and these findings support the need to re-evaluate the conduct, methodology and analysis procedures of international trials to ensure that the generalizability of study findings can accurately be determined,” they said.
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