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Beta-blockers for congestive heart failure in children
Samer Alabed1, Ammar Sabouni2, Suleiman Al Dakhoul3
1Academic Unit of Radiology, University of Sheffield, Sheffield, UK.
Insights
Limited evidence suggests beta-blockers may benefit children with congestive heart failure, but more research is needed. Paediatric dosing schemes require further investigation due to differing characteristics and drug clearance in children compared to adults.
Area of Science:
- Cardiology
- Paediatric Medicine
- Pharmacology
Background:
- Congestive heart failure in children presents unique characteristics, etiology, and drug clearance compared to adults.
- Beta-blockers are a standard therapy for adult congestive heart failure, prompting investigation into their pediatric use.
- This review is an update of previous Cochrane reviews on beta-blocker efficacy in pediatric congestive heart failure.
Purpose of the Study:
- To evaluate the effectiveness of beta-adrenoceptor-blockers (beta-blockers) in treating congestive heart failure in pediatric patients.
- To synthesize evidence from randomized controlled trials regarding beta-blocker therapy in children with heart failure.
Main Methods:
- Searched major databases (CENTRAL, MEDLINE, EMBASE, LILACS) up to November 2015 for relevant studies.
- Included randomized controlled trials investigating beta-blocker effects on pediatric congestive heart failure.
- Two independent reviewers extracted and assessed data from included trials.
Main Results:
- Seven studies with 420 participants were included; results were mixed, with some showing improvement and one showing no benefit over placebo.
- No significant differences in mortality or heart transplantation rates were observed between beta-blocker and control groups.
- A small improvement in left ventricular ejection fraction (LVEF) and fractional shortening (LVFS) was noted, but heterogeneity in study populations and methods precluded meta-analysis of primary outcomes.
Conclusions:
- Insufficient evidence exists to definitively support or refute beta-blocker use in pediatric congestive heart failure or to establish dosing guidelines.
- Sparse data suggest potential benefits, warranting further research with standardized methodologies in well-defined pediatric populations.
- Pharmacokinetic studies are essential for developing effective dosing strategies for future pediatric trials.
Background:
Beta-blockers are an essential part of standard therapy in adult congestive heart failure and therefore, are expected to be beneficial in children. However, congestive heart failure in children differs from that in adults in terms of characteristics, aetiology, and drug clearance. Therefore, paediatric needs must be specifically investigated. This is an update of a Cochrane review previously published in 2009.
Objectives:
To assess the effect of beta-adrenoceptor-blockers (beta-blockers) in children with congestive heart failure.
Search Methods:
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, and LILACS up to November 2015. Bibliographies of identified studies were checked. No language restrictions were applied.
Selection Criteria:
Randomised, controlled, clinical trials investigating the effect of beta-blocker therapy on paediatric congestive heart failure.
Data Collection And Analysis:
Two review authors independently extracted and assessed data from the included trials.
Main Results:
We identified four new studies for the review update; the review now includes seven studies with 420 participants. Four small studies with 20 to 30 children each, and two larger studies of 80 children each, showed an improvement of congestive heart failure with beta-blocker therapy. A larger study with 161 participants showed no evidence of benefit over placebo in a composite measure of heart failure outcomes. The included studies showed no significant difference in mortality or heart transplantation rates between the beta-blocker and control groups. No significant adverse events were reported with beta-blockers, apart from one episode of complete heart block. A meta-analysis of left ventricular ejection fraction (LVEF) and fractional shortening (LVFS) data showed a very small improvement with beta-blockers. However, there were vast differences in the age, age range, and health of the participants (aetiology and severity of heart failure; heterogeneity of diagnoses and co-morbidities); there was a range of treatments across studies (choice of beta-blocker, dosing, duration of treatment); and a lack of standardised methods and outcome measures. Therefore, the primary outcomes could not be pooled in meta-analyses.
Authors' Conclusions:
There is not enough evidence to support or discourage the use of beta-blockers in children with congestive heart failure, or to propose a paediatric dosing scheme. However, the sparse data available suggested that children with congestive heart failure might benefit from beta-blocker treatment. Further investigations in clearly defined populations with standardised methodology are required to establish guidelines for therapy. Pharmacokinetic investigations of beta-blockers in children are also required to provide effective dosing in future trials.
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