Abstract
Aims Recent guidelines recommend that patients with heart failure and left ventricular ejection fraction (LVEF) 40-49% should be managed similar to LVEF ≥ 50%. We investigated the effect of beta-blockers according to LVEF in double-blind, randomized, placebo-controlled trials. Methods and results Individual patient data meta-Analysis of 11 trials, stratified by baseline LVEF and heart rhythm (Clinicaltrials.gov: NCT0083244; PROSPERO: CRD42014010012). Primary outcomes were all-cause mortality and cardiovascular death over 1.3 years median follow-up, with an intention-To-Treat analysis. For 14 262 patients in sinus rhythm, median LVEF was 27% (interquartile range 21-33%), including 575 patients with LVEF 40-49% and 244 ≥ 50%. Beta-blockers reduced all-cause and cardiovascular mortality compared to placebo in sinus rhythm, an effect that was consistent across LVEF strata, except for those in the small subgroup with LVEF ≥ 50%. For LVEF 40-49%, death occurred in 21/292 [7.2%] randomized to beta-blockers compared to 35/283 [12.4%] with placebo; adjusted hazard ratio (HR) 0.59 [95% confidence interval (CI) 0.34-1.03]. Cardiovascular death occurred in 13/292 [4.5%] with beta-blockers and 26/283 [9.2%] with placebo; adjusted HR 0.48 (95% CI 0.24-0.97). Over a median of 1.0 years following randomization (n = 4601), LVEF increased with beta-blockers in all groups in sinus rhythm except LVEF ≥50%. For patients in atrial fibrillation at baseline (n = 3050), beta-blockers increased LVEF when < 50% at baseline, but did not improve prognosis. Conclusion Beta-blockers improve LVEF and prognosis for patients with heart failure in sinus rhythm with a reduced LVEF. The data are most robust for LVEF < 40%, but similar benefit was observed in the subgroup of patients with LVEF 40-49%.
| Original language | English |
|---|---|
| Journal | European Heart Journal |
| DOIs | |
| Publication status | Accepted/In press - 2017 |
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Keywords
- Atrial fibrillation
- Beta-blockers
- Ejection fraction
- Heart failure
- Mortality
- Sinus rhythm
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
Cite this
Beta-blockers for heart failure with reduced, mid-range, and preserved ejection fraction : An individual patient-level analysis of double-blind randomized trials. / Cleland, John G.F.; Bunting, Karina V.; Flather, Marcus D.; Altman, Douglas G.; Holmes, Jane; Coats, Andrew J.S.; Manzano, Luis; McMurray, John J.V.; Ruschitzka, Frank; Van Veldhuisen, Dirk J.; Von Lueder, Thomas G.; Böhm, Michael; Andersson, Bert; Kjekshus, John; Packer, Milton; Rigby, Alan S.; Rosano, Giuseppe; Wedel, Hans; Hjalmarson, Åke; Wikstrand, John; Kotecha, Dipak.
In: European Heart Journal, 2017.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Beta-blockers for heart failure with reduced, mid-range, and preserved ejection fraction
T2 - An individual patient-level analysis of double-blind randomized trials
AU - Cleland, John G.F.
AU - Bunting, Karina V.
AU - Flather, Marcus D.
AU - Altman, Douglas G.
AU - Holmes, Jane
AU - Coats, Andrew J.S.
AU - Manzano, Luis
AU - McMurray, John J.V.
AU - Ruschitzka, Frank
AU - Van Veldhuisen, Dirk J.
AU - Von Lueder, Thomas G.
AU - Böhm, Michael
AU - Andersson, Bert
AU - Kjekshus, John
AU - Packer, Milton
AU - Rigby, Alan S.
AU - Rosano, Giuseppe
AU - Wedel, Hans
AU - Hjalmarson, Åke
AU - Wikstrand, John
AU - Kotecha, Dipak
PY - 2017
Y1 - 2017
N2 - Aims Recent guidelines recommend that patients with heart failure and left ventricular ejection fraction (LVEF) 40-49% should be managed similar to LVEF ≥ 50%. We investigated the effect of beta-blockers according to LVEF in double-blind, randomized, placebo-controlled trials. Methods and results Individual patient data meta-Analysis of 11 trials, stratified by baseline LVEF and heart rhythm (Clinicaltrials.gov: NCT0083244; PROSPERO: CRD42014010012). Primary outcomes were all-cause mortality and cardiovascular death over 1.3 years median follow-up, with an intention-To-Treat analysis. For 14 262 patients in sinus rhythm, median LVEF was 27% (interquartile range 21-33%), including 575 patients with LVEF 40-49% and 244 ≥ 50%. Beta-blockers reduced all-cause and cardiovascular mortality compared to placebo in sinus rhythm, an effect that was consistent across LVEF strata, except for those in the small subgroup with LVEF ≥ 50%. For LVEF 40-49%, death occurred in 21/292 [7.2%] randomized to beta-blockers compared to 35/283 [12.4%] with placebo; adjusted hazard ratio (HR) 0.59 [95% confidence interval (CI) 0.34-1.03]. Cardiovascular death occurred in 13/292 [4.5%] with beta-blockers and 26/283 [9.2%] with placebo; adjusted HR 0.48 (95% CI 0.24-0.97). Over a median of 1.0 years following randomization (n = 4601), LVEF increased with beta-blockers in all groups in sinus rhythm except LVEF ≥50%. For patients in atrial fibrillation at baseline (n = 3050), beta-blockers increased LVEF when < 50% at baseline, but did not improve prognosis. Conclusion Beta-blockers improve LVEF and prognosis for patients with heart failure in sinus rhythm with a reduced LVEF. The data are most robust for LVEF < 40%, but similar benefit was observed in the subgroup of patients with LVEF 40-49%.
AB - Aims Recent guidelines recommend that patients with heart failure and left ventricular ejection fraction (LVEF) 40-49% should be managed similar to LVEF ≥ 50%. We investigated the effect of beta-blockers according to LVEF in double-blind, randomized, placebo-controlled trials. Methods and results Individual patient data meta-Analysis of 11 trials, stratified by baseline LVEF and heart rhythm (Clinicaltrials.gov: NCT0083244; PROSPERO: CRD42014010012). Primary outcomes were all-cause mortality and cardiovascular death over 1.3 years median follow-up, with an intention-To-Treat analysis. For 14 262 patients in sinus rhythm, median LVEF was 27% (interquartile range 21-33%), including 575 patients with LVEF 40-49% and 244 ≥ 50%. Beta-blockers reduced all-cause and cardiovascular mortality compared to placebo in sinus rhythm, an effect that was consistent across LVEF strata, except for those in the small subgroup with LVEF ≥ 50%. For LVEF 40-49%, death occurred in 21/292 [7.2%] randomized to beta-blockers compared to 35/283 [12.4%] with placebo; adjusted hazard ratio (HR) 0.59 [95% confidence interval (CI) 0.34-1.03]. Cardiovascular death occurred in 13/292 [4.5%] with beta-blockers and 26/283 [9.2%] with placebo; adjusted HR 0.48 (95% CI 0.24-0.97). Over a median of 1.0 years following randomization (n = 4601), LVEF increased with beta-blockers in all groups in sinus rhythm except LVEF ≥50%. For patients in atrial fibrillation at baseline (n = 3050), beta-blockers increased LVEF when < 50% at baseline, but did not improve prognosis. Conclusion Beta-blockers improve LVEF and prognosis for patients with heart failure in sinus rhythm with a reduced LVEF. The data are most robust for LVEF < 40%, but similar benefit was observed in the subgroup of patients with LVEF 40-49%.
KW - Atrial fibrillation
KW - Beta-blockers
KW - Ejection fraction
KW - Heart failure
KW - Mortality
KW - Sinus rhythm
UR - http://www.scopus.com/inward/record.url?scp=85040672527&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85040672527&partnerID=8YFLogxK
U2 - 10.1093/eurheartj/ehx564
DO - 10.1093/eurheartj/ehx564
M3 - Article
AN - SCOPUS:85040672527
JO - European Heart Journal
JF - European Heart Journal
SN - 0195-668X
ER -