Beta-blockers for congestive heart failure in children

Area of Science:

• Pediatric Cardiology
• Pharmacology
• Clinical Trials

Background:

• Beta-blockers are standard treatment for adult congestive heart failure (CHF).
• Pediatric CHF differs significantly from adult CHF in characteristics, etiology, and drug clearance.
• Specific investigation of beta-blocker efficacy in children is warranted.

Purpose of the Study:

• To assess the effects of beta-adrenoceptor-blockers (beta-blockers) in children diagnosed with congestive heart failure.

Main Methods:

• Systematic review and update of a previous Cochrane review.
• Searched multiple databases (CENTRAL, MEDLINE, EMBASE, LILACS) up to November 2015.
• Included randomized controlled trials investigating beta-blocker therapy in pediatric CHF.

Main Results:

• Seven studies with 420 participants were included.
• Four studies indicated improvement with beta-blockers; one larger study showed no benefit over placebo.
• No significant differences in mortality or heart transplantation rates; minor adverse events reported.
• Meta-analysis showed a small improvement in left ventricular ejection fraction (LVEF) and fractional shortening (LVFS).
• Significant heterogeneity in participant populations, treatments, and outcome measures precluded primary outcome pooling.

Conclusions:

• Insufficient evidence exists to support or refute beta-blocker use in pediatric CHF.
• Current sparse data suggest potential benefit, but further high-quality, standardized trials are necessary.
• Pharmacokinetic studies are needed to establish appropriate pediatric dosing regimens.