Related Experiment Video

Updated: Jul 15, 2025

Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction
09:20

Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction

Published on: February 13, 2021

6.5K

Contemporary Use and Implications of Beta-Blockers in Patients With HFmrEF or HFpEF: The DELIVER Trial

Alexander Peikert1, Bradley A Bart2, Muthiah Vaduganathan1

  • 1Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.

JACC. Heart Failure
|September 28, 2023
PubMed

Insights

Beta-blocker use is common in heart failure with preserved ejection fraction (HFpEF) and heart failure with mildly reduced ejection fraction (HFmrEF) and does not increase adverse outcomes. Dapagliflozin effectively and safely reduced cardiovascular events in these patients, regardless of beta-blocker use.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Trials

Background:

  • Beta-blockers are frequently prescribed for comorbidities in heart failure with preserved ejection fraction (HFpEF), despite not being guideline-recommended for HFpEF treatment.
  • Concerns exist regarding potential adverse effects of beta-blockers on chronotropic response and clinical outcomes in HFpEF patients.

Purpose of the Study:

  • To investigate the current utilization patterns of beta-blockers in patients diagnosed with HFpEF or HFmrEF.
  • To evaluate the clinical implications and safety of beta-blocker therapy in this patient population within the context of the DELIVER trial.

Main Methods:

  • Analysis of data from the DELIVER trial, which randomized 6,263 patients with LVEF >40% to dapagliflozin or placebo.
  • A prespecified analysis examined efficacy and safety outcomes based on the use of beta-blockers at the time of randomization.
  • The primary endpoint was defined as the composite of cardiovascular death or worsening heart failure.

Main Results:

  • Beta-blockers were utilized by 83% of participants, with significant regional variations in prescription rates.
  • Beta-blocker use was associated with a reduced risk of the primary outcome (cardiovascular death or worsening HF) in adjusted analyses.
  • Dapagliflozin demonstrated consistent efficacy in reducing the primary outcome in both beta-blocker users and non-users, with no significant interaction effect. Safety profiles were similar across groups.

Conclusions:

  • The majority of patients with HFmrEF or HFpEF in the DELIVER trial were treated with beta-blockers.
  • Beta-blocker therapy was not linked to an increased risk of adverse cardiovascular events or worsening heart failure in this cohort.
  • Dapagliflozin provided consistent and safe clinical benefits for patients with HFmrEF/HFpEF, irrespective of their background beta-blocker treatment.
Abstract

Keywords:
SGLT2 inhibitorsbeta-blockersheart failure with mildly reduced ejection fractionheart failure with preserved ejection fraction

More Related Videos

A Surgical Model of Heart Failure with Preserved Ejection Fraction in Tibetan Minipigs07:09

A Surgical Model of Heart Failure with Preserved Ejection Fraction in Tibetan Minipigs

Published on: February 18, 2022

1.9K
Author Spotlight: Investigating HR-Dependent Cardiac Function in Mouse Models Through a Novel Atrial-Pacing Approach07:49

Author Spotlight: Investigating HR-Dependent Cardiac Function in Mouse Models Through a Novel Atrial-Pacing Approach

Published on: July 21, 2023

1.4K

Related Concept Videos

Heart Failure Drugs: β-Blockers01:22

Heart Failure Drugs: β-Blockers

β-adrenergic antagonists, commonly known as β-blockers, block the effects of sympathetic neurotransmitters such as noradrenaline (NA) and adrenaline (ADR). They have several beneficial effects in heart failure treatment. They reduce heart rate, the force of contraction, and cardiac muscle relaxation. They also slow the atrial-ventricular conduction rate and raise the threshold for arrhythmias. The concentration of β-blockers determines their effects on bronchodilation,...
357
Adrenergic Antagonists: Pharmacological Actions of β-Receptor Blockers01:27

Adrenergic Antagonists: Pharmacological Actions of β-Receptor Blockers

β-receptor blockers significantly impact the cardiovascular system by counteracting catecholamine-induced sympathetic responses. These medications decrease heart rate, contractility, and cardiac output, potentially leading to cardiac depression, life-threatening bradycardia, and death. Therapeutically, β-blockers function as mild antihypertensives and are utilized in treating angina pectoris and cardiac arrhythmias. However, nonselective β-blockers inhibit β2-receptors in...
881
Antihypertensive Drugs: Types of β-Blockers01:28

Antihypertensive Drugs: Types of β-Blockers

β receptors are classified into three subclasses: β1, β2, and β3. β1 receptors are primarily located in the heart and kidneys. When they get activated, they increase heart rate, contractility, and renin release. This process enhances blood pressure and aids in stress management. In contrast, β2 receptors are situated mainly in the lungs, blood vessels, and skeletal muscles. Upon activation, they trigger smooth muscle relaxation, causing bronchodilation and...
723
Heart Failure V: Medical Management01:30

Heart Failure V: Medical Management

Medical Management of Acute Decompensated Heart Failure (ADHF)The primary goals of therapy for patients hospitalized with acute decompensated heart failure (ADHF) include:Relieving symptomsOptimizing volume statusSupporting oxygenation and ventilationMaintaining cardiac output (CO) and end-organ perfusionIdentifying and addressing the cause of ADHFPreventing complicationsProviding patient education on factors precipitating HF exacerbationPlanning for dischargeOngoing monitoring and assessment...
12
Adrenergic Antagonists: Chemistry and Classification of β-Receptor Blockers01:25

Adrenergic Antagonists: Chemistry and Classification of β-Receptor Blockers

β-adrenergic antagonists, or β-blockers, modulate the sympathetic nervous system by targeting β-adrenoceptors and inhibiting catecholamine-mediated sympathetic responses. β-blockers differ in their adrenoceptor subtype affinity, lipophilicity, and α-blocking capabilities. The history of β-blocker development began with the prototype, dichloroisoprenaline, which exhibited partial agonist activity. As a result, propranolol was developed as a pure antagonist but...
652
Adrenergic Antagonists: ɑ and β-Receptor Blockers01:31

Adrenergic Antagonists: ɑ and β-Receptor Blockers

Third-generation β-blockers, such as labetalol and carvedilol, represent a significant advancement in managing cardiovascular conditions. Unlike conventional β-blockers, which can induce peripheral vasoconstriction, third-generation drugs block α1 adrenoceptors. This promotes vasodilation through several mechanisms, such as increased nitric oxide production, inhibition of calcium ion entry, opening of potassium ion channels, and antioxidant action. Labetalol, for instance, is...
507