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Published on: February 26, 2013
Beta-blockers and outcome in heart failure and atrial fibrillation: a meta-analysis
Michiel Rienstra1, Kevin Damman1, Bart A Mulder1
1Department of Cardiology, University of Groningen, University Medical Center Groningen, the Netherlands.
Insights
Beta-blockers show limited benefit in reducing mortality for heart failure patients with atrial fibrillation. These findings suggest a reduced effect compared to patients in sinus rhythm, impacting treatment guidelines.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Medicine
Background:
- Beta-blockers are standard therapy for heart failure (HF).
- Current HF guidelines for beta-blocker use are based on studies predominantly including patients with sinus rhythm.
- The efficacy of beta-blockers in patients with co-existing HF and atrial fibrillation (AF) remains uncertain.
Purpose of the Study:
- To evaluate the impact of beta-blocker therapy on clinical outcomes in patients diagnosed with heart failure and atrial fibrillation.
- To compare the effectiveness of beta-blockers in patients with heart failure and atrial fibrillation versus those with heart failure and sinus rhythm.
Main Methods:
- Systematic review and meta-analysis of placebo-controlled, randomized trials.
- Inclusion criteria: patients with heart failure and reduced left ventricular ejection fraction (LVEF < 40%) and baseline atrial fibrillation.
- Analysis focused on mortality and hospitalization rates.
Main Results:
- Four studies involving 8,680 patients (1,677 with AF) were analyzed.
- Beta-blockade did not significantly reduce mortality in patients with AF (OR: 0.86; p=0.28), unlike in sinus rhythm patients (OR: 0.63; p<0.0001).
- Beta-blocker therapy was not associated with reduced HF hospitalizations in AF patients (OR: 1.11; p=0.44), contrasting with sinus rhythm patients (OR: 0.58; p<0.0001).
Conclusions:
- Beta-blocker therapy demonstrates a diminished effect on outcomes for heart failure patients with atrial fibrillation compared to those in sinus rhythm.
- Significant interactions were observed regarding the effects of beta-blockers in AF versus sinus rhythm populations.
- Findings suggest a need to reconsider current guidelines for beta-blocker use in heart failure patients with atrial fibrillation.
Objectives:
The purpose of this study was to analyze the effect of beta blockade on outcome in patients with heart failure (HF) and atrial fibrillation (AF).
Background:
Beta-blockers are widely used in patients with HF and AF. Recommendation in current HF guidelines, however, is based on populations in which the most patients had sinus rhythm. Whether beta-blockers are as useful in AF is uncertain.
Methods:
Studies were included that investigated the effect of placebo-controlled, randomized beta-blocker therapy in patients with AF at baseline and HF with reduced systolic left ventricular ejection fraction (LVEF) <40%.
Results:
We identified 4 studies, which enrolled 8,680 patients with HF, and 1,677 of them had AF (19%; mean 68 years of age; 30% women); there were 842 patients treated with beta-blocker, and 835 with placebo. In AF patients, beta-blockade did not reduce mortality (odds ratio [OR]: 0.86 [95% confidence interval (CI): 0.66 to 1.13]; p = 0.28), while in sinus rhythm patients, there was a significant reduction (OR: 0.63 [95% CI: 0.54 to 0.73]; p < 0.0001). Interaction analysis showed significant interaction of the effects of beta-blocker therapy in AF versus that in sinus rhythm (p = 0.048). By meta-regression analysis, we did not find confounding by all relevant covariates. Beta-blocker therapy was not associated with a reduction in HF hospitalizations in AF (OR: 1.11 [95% CI: 0.85 to 1.47]; p = 0.44), in contrast to sinus rhythm (OR: 0.58 [95% CI: 0.49 to 0.68]; p < 0.0001). There was a significant interaction of the effects of beta-blocker therapy in AF versus that in sinus rhythm (p < 0.001).
Conclusions:
Our findings suggest that the effect of beta-blockers on outcome in HF patients with reduced systolic LVEF who have AF is less than in those who have sinus rhythm.
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