Related Experiment Video
Updated: Aug 15, 2026
07:09
A Surgical Model of Heart Failure with Preserved Ejection Fraction in Tibetan Minipigs
Published on: February 18, 2022
Beta-Blocker Discontinuation in Heart Failure with Preserved or Improved Ejection Fraction: A Systematic Review
Wade Thompson1, Nima Alaeiilkhchi1, Lisa M McCarthy2
1Department of Anesthesiology, Pharmacology, and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, Canada.
Journal of Cardiac Failure
|August 13, 2026
Summary
Discontinuing beta-blockers in heart failure with preserved ejection fraction (HFpEF) may improve function and quality of life short-term. Evidence for long-term benefits or effects in HFimpEF is limited and conflicting.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Medicine
Background:
- Beta-blockers are frequently prescribed for heart failure with preserved or improved ejection fraction (HFpEF/HFimpEF).
- The clinical utility and safety of continued beta-blocker use in these specific heart failure populations remain uncertain.
- This uncertainty prompts investigation into the potential benefits and risks of discontinuing beta-blockers.
Purpose of the Study:
- To systematically review the effects of discontinuing beta-blockers compared to continuing them in adult patients with HFpEF or HFimpEF.
- To evaluate the impact on mortality, cardiovascular events, hospitalizations, functional capacity, quality of life, and physiological parameters.
Main Methods:
- A systematic literature search was conducted across multiple databases (MEDLINE, Embase, Cochrane CENTRAL, etc.) up to September 11, 2025.
- Included studies comprised randomized controlled trials (RCTs), quasi-randomized studies, and non-randomized studies.
- A narrative synthesis approach was employed to analyze the extracted data.
Main Results:
- In HFpEF, beta-blocker discontinuation showed short-term improvements in functional capacity and quality of life (at 2 weeks) without clear effects on cognition or biomarkers.
- Long-term outcomes and effects on major clinical endpoints following beta-blocker discontinuation in HFpEF remain unclear.
- For HFimpEF, discontinuation did not appear to significantly alter cardiovascular parameters or clinical status, though long-term outcome data were conflicting.
Conclusions:
- The current evidence base regarding beta-blocker discontinuation in HFpEF and HFimpEF is limited and derived from heterogeneous patient groups.
- Further high-quality randomized controlled trials focusing on long-term clinical outcomes are essential to resolve the uncertainties surrounding the benefits and harms of stopping beta-blockers in these populations.
Related Concept Videos
01:22Heart 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, vasodilation, and...
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
The activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) contributes to cardiac remodeling, and inhibiting the RAAS is a pharmacological target in heart failure management. As a result, neurohumoral modulation is a crucial treatment principle for managing heart failure. This approach involves using medications like ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers, mineralocorticoid receptor antagonists (MRAs), and neutral...
01:30Heart 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...
01:27Adrenergic 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 bronchial smooth...
01:28Antihypertensive 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 vasodilation. This widens airways and...
01:22Heart Failure Drugs: Diuretics
Heart failure and kidney perfusion are interconnected in a complex way. Reduced renal perfusion and venous congestion are two significant factors that contribute to renal dysfunction in heart failure. The kidneys, primarily responsible for fluid balance in the body, are adversely affected due to compromised cardiac output and increased venous pressure. In response to reduced renal perfusion, the kidneys activate neurohumoral mechanisms to restore balance. However, these mechanisms can be...