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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.
The Cochrane Database of Systematic Reviews
|July 24, 2020
Summary
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.
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