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Prognosis of heart failure with preserved ejection fraction treated with β-blockers: A propensity matched study in
Gema Ruiz1, Jose L Andrey1, Jose L Puerto1
1Department of Medicine, Hospital Universitario Puerto Real, University of Cadiz, School of Medicine, Spain.
Insights
Starting treatment with bisoprolol or carvedilol improves outcomes for patients with heart failure with preserved ejection fraction (HFpEF). This beta-blocker therapy was linked to reduced mortality and hospitalizations in a large, long-term study.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Medicine
Background:
- The prognostic impact of beta-blocker therapy in newly diagnosed heart failure with preserved ejection fraction (HFpEF) remains unclear.
- Existing research has not definitively established the benefits of specific beta-blockers for HFpEF patients.
Purpose of the Study:
- To investigate the association between initiating treatment with bisoprolol or carvedilol (CT-βB) and the prognosis of patients newly diagnosed with HFpEF.
- To analyze the long-term effects of CT-βB on mortality and hospitalization rates in this patient population.
Main Methods:
- A prospective, 10-year study involving 2704 patients diagnosed with HFpEF.
- Propensity score-matching was employed to compare 985 patients on CT-βB with 985 patients not on CT-βB, adjusting for cardiovascular comorbidities.
- Primary outcomes included all-cause and cardiovascular mortality, and hospitalizations for HF worsening.
Main Results:
- Commencing CT-βB was associated with a significantly lower risk of all-cause mortality (HR 0.78) and cardiovascular mortality (HR 0.75).
- Patients on CT-βB experienced lower hospitalization rates (15.8 vs. 19.2 per 100 person-years) and 30-day readmission rates (4.0 vs. 5.8 per 100 person-years).
- These benefits were observed regardless of beta-blocker dosage, gender, or other confounding factors.
Conclusions:
- Initiating treatment with bisoprolol or carvedilol is associated with an improved prognosis in patients newly diagnosed with HFpEF.
- Both high and lower doses of these beta-blockers demonstrated a positive impact on patient outcomes.
- The findings support the use of bisoprolol and carvedilol in managing newly diagnosed HFpEF.
Background:
The effect of treatment with β-blockers on the prognosis of patients newly diagnosed with heart failure with preserved ejection fraction (HFpEF) is unknown.
Objective:
To analyze the relationship of commencing treatment with the β-blockers bisoprolol or carvedilol (CT-βB) with the prognosis of newly diagnosed HFpEF.
Methods:
Prospective study over 10years on 2704 patients with HFpEF. Main outcomes were mortality (all-cause and cardiovascular), hospitalizations for HF worsening, and visits. The independent relationship between CT-βB and the prognosis, stratifying patients for cardiovascular co-morbidity after propensity score-matching (985 patients CT-βB vs. another 985 patients non-CT-βB), was analyzed.
Results:
During a median follow-up of 1877.4days (interquartile range, 1-3651.2) 1600 died (81.2%), and 1702 were hospitalized (86.4%). CT-βB was associated with a lower risk of mortality (all-cause: HR [CI 95%] 0.78 [0.71 to 0.85], and cardiovascular: 0.75 [0.69 to 0.82]), a lower hospitalization rate (per 100 persons-year), 15.8 vs. 19.2, and a lower 30-day readmission rate (per 100 persons-year), 4.0 vs. 5.8, (P<0.001 in all cases), even after adjustment for the propensity to take β-blockers or other medications, comorbidities, and other potential confounders. These effects of CT-βB were independent of gender, and were observed in both patients taking high dose βB (over the median dose) and lower dose βB (under or equal to the median dose).
Conclusions:
In this propensity matched study, commencing treatment with bisoprolol or carvedilol, both at high and at lower doses, is associated with an improved prognosis of patients newly diagnosed with HFpEF.
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