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Beta-blocker therapy for congestive heart failure: a systemic overview and critical appraisal of the published trials
A Avezum1, R T Tsuyuki, J Pogue
1Dante Pazzanese Cardiology Institute, São Paulo, Brazil.
Insights
Beta-blockers show promising results for congestive heart failure (CHF) patients, reducing mortality and hospitalizations. However, more large-scale trials are needed to confirm these benefits for beta-blocker therapy in heart failure.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Trials
Background:
- Congestive heart failure (CHF) is a major cause of morbidity and mortality.
- Beta-blockers are a class of drugs commonly used for cardiovascular conditions.
Purpose of the Study:
- To evaluate the impact of beta-blockers on mortality and morbidity in patients with congestive heart failure (CHF).
- To assess the reliability and completeness of existing data on beta-blocker use in CHF.
Main Methods:
- A comprehensive MEDLINE search was conducted to identify relevant randomized trials.
- Included were trials of beta-blockers versus placebo in patients with CHF, with a duration exceeding one month.
- Data from 18 published trials involving 2986 patients were analyzed.
Main Results:
- Beta-blocker treatment was associated with a statistically significant reduction in mortality (8.2% vs. 12.6%) and hospitalization for heart failure (18.1% vs. 28.7%).
- A trend towards a lower rate of heart transplantation was observed (1.1% vs. 2.7%).
- Ventricular function improved, but exercise duration showed no significant change.
Conclusions:
- The current data on beta-blockers for CHF are promising but not yet robust or complete.
- Further large-scale trials are necessary to provide conclusive evidence on the efficacy and safety of beta-blockers in heart failure management.
- Routine clinical use of beta-blockers in CHF patients should be deferred pending results from ongoing studies.
Objective:
To evaluate the effect of beta-blockers on mortality and morbidity, and to provide an appraisal of the reliability of the available data.
Data Sources:
MEDLINE search for trials of beta-blockers for congestive heart failure (CHF).
Study Selection:
All randomized trials of beta-blockers versus placebo, or greater than one month's duration, in patients with CHF. Eighteen published trials involving 2986 patients were selected.
Data Extraction:
Independently by two authors.
Data Synthesis:
The Yusuf-Peto method for combining data was used. Data were available on mortality in 2841 patients (95%), on hospitalization for heart failure in 1514 (51%) and on heart transplantation in 2330 (79%). There was a lower rate of death in the active treatment group (131 of 1606) [8.2] versus 155 of 1235 [12.6%]; OR = 72; 99% CI 0.51 to 1.00), a lower rate of hospitalization for heart failure (137 of 756 [18.1%] versus 218 of 758 [28.7%]; OR = 0.54; 99% CI 0.39 to 0.74) and a trend towards a lower proportion of patients receiving heart transplantation (15 of 1354 [l.1%] versus 26 of 976 [2.7%]; OR = 0.45; 99% CI 0.20 to 1.03). Ventricular function improved; however, there was no effect on exercise duration. Although the effects on mortality were nominally statistically significant, the use of formal methods of interim monitoring adapted for meta-analyses suggests that substantially more patients still need to be studied in large scales trials to provide reliable and conclusive evidence.
Conclusions:
While the available data on the use of beta-blockers in CHF appear to be promising, they are neither complete nor robust. The routine use of beta-blockers in patients with heart failure should wait the results of ongoing studies.