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Beta-blockers in heart failure with preserved ejection fraction: a meta-analysis

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Abstract

Beta-blockers are established drugs in heart failure with reduced ejection fraction, but their role in heart failure with preserved ejection fraction (HFpEF) is not established. Hence, we undertook a meta-analysis to evaluate the efficacy of beta-blockers on mortality and morbidity in HFpEF patients. A systematic search using PubMed, Embase, Scopus and Cochrane databases was performed to identify all relevant studies on beta-blockers and HFpEF. A random-effects model was performed to assess the role of beta-blockers on all-cause mortality and HF hospitalization. Overall 15 observational studies and two randomized control trial involving a total of 27,099 patients were included in the analysis. In the observational studies, beta-blocker therapy was associated with lower all-cause mortality [RR 0.81 (0.72–0.90), p < 0.001], but not HF hospitalization [RR 0.79 (0.57–1.10), p < 0.001]. However, in the two RCTs, the use of beta-blocker was not associated with all-cause mortality [RR 0.94 (0.67–1.32), p = 0.72] or HF hospitalization [0.90 (0.54–1.49), p = 0.68]. The results were consistent by geographic region (USA vs. rest of world) and ejection fraction subgroups. Subgroup analysis revealed that the beneficial survival effect of beta-blocker was limited to studies with mean age <75 years. Observational studies showed a significant benefit from the use of beta-blockers for all-cause mortality, but not for HF hospitalization. Beta-blockers in the two RCTs were not associated with significant reduction in all-cause mortality or HF hospitalization; however, both the trials were not adequately powered and had high loss to follow-up rates. Further large sampled well-conducted randomized trials are warranted to confirm the effects of beta-blockers on mortality and hospitalization.

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Conflict of interest

Dr. Franz Messerli acts as a consultant for Daiichi-Sankyo, Pfizer, Takeda, Abbott, Servier, Medtronic and Ipca Laboratories Ltd. Dr. Chirag Bavishi, Dr. Saurav Chatterjee, Dr Sameer Ather and Dr. Dipen Patel have no conflicts of interest or financial ties to disclose.

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  1. Department of Medicine, Mount Sinai St. Luke’s-Roosevelt Hospital, Icahn School of Medicine at Mount Sinai, 1000 Tenth Ave, New York, NY, 10019, USA

    Chirag Bavishi, Saurav Chatterjee, Dipen Patel & Franz H. Messerli

  2. Division of Cardiovascular diseases, University of Alabama at Birmingham, Birmingham, AL, USA

    Sameer Ather

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  1. Chirag Bavishi
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  2. Saurav Chatterjee
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Bavishi, C., Chatterjee, S., Ather, S. et al. Beta-blockers in heart failure with preserved ejection fraction: a meta-analysis. Heart Fail Rev 20, 193–201 (2015). https://doi.org/10.1007/s10741-014-9453-8

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