Are β-Blockers Necessary for Patients with Heart Failure with Preserved Ejection Fraction? : PurSuit-HFpEF Registry

The effect of β-blockers on heart failure (HF) with preserved ejection fraction (HFpEF) remains controversial. One proposed reason is the confounding influence of common comorbidities such as atrial fibrillation (AF) and ischemic heart disease (IHD), which may obscure the influence of β-blockers on HFpEF outcomes.

From the PURSUIT-HFpEF registry (UMIN000021831), patients were divided into two groups: AF/IHD (with AF and/or IHD) and non-AF/IHD (without both). Prognosis was compared between β-blocker users and non-users in each group. Inverse probability of treatment weighting (IPTW) was performed as the primary adjustment method. In AF/IHD cohort (n=687; β-blocker 361, non-β-blocker 326), outcomes did not differ for the composite endpoint, all-cause death, or HF rehospitalization. In contrast, in non-AF/IHD patients (n=537; β-blocker 203, non-β-blocker 334), β-blocker use was linked to poorer outcomes. In IPTW-weighted analyses, β-blocker use was not associated with the composite endpoint, all-cause death, or HF rehospitalization in the AF/IHD group. In contrast, among non-AF/IHD patients, β-blocker use was associated with a higher risk of all-cause death (p=0.046, hazard ratio [HR] 1.448, 95% confidence interval [CI] 1.007-2.082) and cardiac death (p=0.001, HR 2.380, 95% CI 1.406-4.027), as well as a higher risk of cardiac composite outcomes (p=0.039, HR 1.441, 95% CI 1.018-2.039). Formal interaction testing between β-blocker use and AF/IHD status was not statistically significant across endpoints.

In HFpEF patients without AF or IHD, β-blocker use was associated with higher mortality-related risk, indicating that routine β-blocker use in this subgroup should be interpreted with caution.