This article is more than 5 years old. Information may no longer be current.
Beta-blockers lowered all-cause mortality in patients with HFpEF
Click Here to Manage Email Alerts
Patients with HF with preserved ejection fraction who received treatment with beta-blockers had lower rates of all-cause mortality, according to new study results.
However, the same trend was not observed with beta-blocker use and combined all-cause mortality and hospitalization for HF in this patient population.
Lars H. Lund, MD, PhD, from Karolinska University Hospital in Stockholm, and colleagues conducted a propensity score-matched cohort study to test the hypothesis that beta-blockers are associated with lower all-cause mortality in patients with HF with preserved ejection fraction (HFpEF). The researchers reviewed data on 41,976 consecutive patients with clinician-judged HF enrolled in the Swedish Heart Failure Registry from July 1, 2005, to Dec. 30, 2012. For this study, HFpEF was defined as EF of ≥40%.
In total, 19,083 patients had HFpEF (mean age, 76 years; 46% women). Patients with HFpEF were matched 2:1 for beta-blocker use (5,496 treated patients, 2,748 untreated patients). The overall patient population was followed for a median of 755 days and the matched cohort was followed for a median of 709 days.
Among the patients with HFpEF, those treated with beta-blockers had a 1-year survival rate of 80% compared with 79% for those who were untreated. The 5-year survival rate was 45% in the treated group vs. 42% in the untreated group. Overall, 2,279 total deaths (41%; 177 per 1,000 patient-years) occurred in patients with HFpEF treated with beta-blockers vs. 1,244 total deaths (42%; 191 per 1,000 patient-years) in the patients who were untreated (HR=0.93; 95% CI, 0.86-0.996).
The researchers found no reduction in combined mortality or HF hospitalization related to beta-blocker use. The treated group experienced 3,368 (61%) total first events vs. 1,753 (64%) total first events in the untreated group. There were 371 first events per 1,000 patient-years in the treated group vs. 378 first events per 1,000 patient-years in the untreated group (HR=0.98; 95% CI, 0.92-1.04).
Lund and colleagues also studied 22,893 patients with HF with reduced EF (HFrEF) for a positive-control consistency analysis. Of those, 6,081 were matched (4,054 treated patients, 2,027 untreated patients). In the matched group of patients with HFrEF, the researchers observed an association between beta-blocker use and decreased mortality (HR=0.89; 95% CI, 0.82-0.97) and with reduced combined mortality or HF hospitalization (HR=0.89; 95% CI, 0.84-0.95).
According to the researchers, the lack of reduction in combined all-cause mortality or HF hospitalization was unexpected and may be related to non-CV comorbidity in patients with HFpEF patients or a paradoxical relationship between mortality and rehospitalization.
“Beta-blockers in HFpEF should be studied in a sufficiently powered randomized clinical trial,” they concluded.
Disclosure: The researchers report no relevant financial disclosures.
Click Here to Manage Email Alerts