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Beta-blockers failed to reduce mortality in patients with HF, AF

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BARCELONA, Spain — Results of a meta-analysis demonstrate that beta-blockers reduced all-cause mortality in patients with HF and sinus rhythm, but not in those with HF and atrial fibrillation.

Researchers analyzed individual patient data from 10 randomized controlled trials comparing beta-blockers with placebo in patients with HF. The data were simultaneously presented at ESC Congress and published in The Lancet.

Dipak Kotecha, MD, PhD, from the University of Birmingham Centre for Cardiovascular Sciences, United Kingdom, and colleagues stratified patients by presence of AF at baseline. The primary outcome was all-cause mortality. Mean follow-up was 1.5 years.

Of 18,254 patients analyzed, 17% had AF at baseline.

The researchers calculated a crude death rate of 16% for patients with sinus rhythm and 21% for patients with AF.

In patients with sinus rhythm, beta-blocker therapy was associated with reduced risk for all-cause mortality (HR=0.73; 95% CI, 0.67-0.8). However, the same reduction in risk was not observed for patients with AF (HR=0.97; 95% CI, 0.83-1.14; P for interaction of baseline rhythm=.002).

In patients with AF, the lack of mortality benefit from beta-blocker therapy was consistent across subgroups, including age, sex, left ventricular ejection fraction, NYHA class, heart rate and baseline medical therapy, according to the researchers.

“Based on our findings, beta-blockers should not be used preferentially over other rate-control medications and not regarded as standard therapy to improve prognosis in patients with concomitant [HF] and [AF],” Kotecha and colleagues wrote in The Lancet.

For more information:

Kotecha D. Abstract #617. Presented at: the European Society of Cardiology Congress; Aug. 30-Sept. 3, 2014; Barcelona, Spain.

Kotecha D. Lancet. 2014;doi:10.1016/S0140-6736(14)61373-8.

Disclosure: The study was funded by a grant from Menarini Farmaceutica Internazionale. Kotecha reports receiving grants and honoraria from Menarini.