Beta-blocker benefit according to severity of heart failure

Beta-blockers are an established treatment for chronic heart failure. However, the relationship between their benefit and the severity of the disease remains to be determined.

We studied the relationship between amplitude of benefit of beta-blockers and severity of chronic heart failure, based on data for mortality and hospitalizations for worsening heart failure, using a meta-analysis of randomized controlled trials, complementary subgroup analyses and analysis of individual data from the CIBIS II trial. In the meta-analysis, mortality was reduced by 22% (95%CI: 16 to 28) and hospitalizations for worsening heart failure by 24% (95%CI: 20 to 29). Benefit was similar with metoprolol, bisoprolol and carvedilol. After exclusion of bucindolol trials, due to the heterogeneity of results for mortality, the reduction in mortality was similar according to the severity of heart failure, assessed either by left ventricular ejection fraction or by New York Heart Association classification. In CIBIS II, beta-blockers induced a significant reduction in mortality of 45% (95%CI: 9 to 66), 41% (95%CI: 17 to 59) and 23% (95%CI: 1 to 40) in the low, intermediate and high risk groups, respectively. Hospitalizations were reduced by 35% (95%CI: 2 to 57), 41% (95%CI: 18 to 58) and 23% (95%CI: 0 to 41), there was no significant difference between the three score groups.

We conclude that the amplitude of benefit of the beta-blockers carvedilol, metoprolol and bisoprolol on mortality and morbidity is similar, regardless of the severity of chronic heart failure.