Cleland JGF, et al. - This study analyzed the data from double-blind, randomized, placebo-controlled trials exploring the impact of beta-blockers in heart failure patients according to left ventricular ejection fraction (LVEF). Data demonstrated that treatment with beta-blockers resulted in improved LVEF and prognosis in patients with heart failure in sinus rhythm with a reduced LVEF. Although more strong data were obtained for LVEF < 40%, it was also revealed that subgroup of patients with LVEF 40–49% derived similar benefit.

Methods

• Researchers performed individual patient data meta-analysis of 11 trials, stratified by baseline LVEF and heart rhythm.
• Primary outcomes were all-cause mortality and cardiovascular death over 1.3 years median follow-up, with an intention-to-treat analysis.

Results

• Findings demonstrated that median LVEF was 27% (interquartile range 21–33%) for 14 262 patients in sinus rhythm, including 575 patients with LVEF 40–49% and 244 ≥ 50%.
• Also, data reported that in sinus rhythm, beta-blockers vs. placebo reduced all-cause and cardiovascular mortality, an impact that was consistent across LVEF strata, except for those in the small subgroup with LVEF ≥ 50%.
• Researchers noted that for LVEF 40–49%, death occurred in 21/292 [7.2%] randomized to beta-blockers compared to 35/283 [12.4%] with placebo; adjusted hazard ratio (HR) 0.59 [95% confidence interval (CI) 0.34–1.03].
• They also found that cardiovascular death occurred in 13/292 [4.5%] with beta-blockers and 26/283 [9.2%] with placebo; adjusted HR 0.48 (95% CI 0.24–0.97).
• Data also revealed that LVEF increased with beta-blockers in all groups in sinus rhythm except LVEF ≥50%, over a median of 1.0 years following randomization (n = 4601).
• It was also evident that for patients in atrial fibrillation at baseline (n = 3050), beta-blockers increased LVEF when < 50% at baseline, but did not improve prognosis.