Cleland, J. G.F. et al. (2018) Beta-blockers for heart failure with reduced, mid-range, and preserved ejection fraction: an individual patient-level analysis of double-blind randomized trials. European Heart Journal, 39(1), pp. 26-35. (doi: 10.1093/eurheartj/ehx564) (PMID:29040525)
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148471.pdf - Accepted Version 2MB |
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%.
Item Type: | Articles |
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Status: | Published |
Refereed: | Yes |
Glasgow Author(s) Enlighten ID: | McMurray, Professor John and Cleland, Professor John |
Authors: | Cleland, J. G.F., Bunting, K. V., Flather, M. D., Altman, D. G., Holmes, J., Coats, A. J.S., Manzano, L., McMurray, J. J.V., Ruschitzka, F., van Veldhuisen, D. J., von Lueder, T. G., Böhm, M., Andersson, B., Kjekshus, J., Packer, M., Rigby, A. S., Rosano, G., Wedel, H., Hjalmarson, Å., Wikstrand, J., and Kotecha, D. |
College/School: | College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre |
Journal Name: | European Heart Journal |
Publisher: | Oxford University Press |
ISSN: | 0195-668X |
ISSN (Online): | 1522-9645 |
Published Online: | 10 October 2017 |
Copyright Holders: | Copyright © 2017 The Authors |
First Published: | First published in European Heart Journal 39(1): 26-35 |
Publisher Policy: | Reproduced in accordance with the publisher copyright policy |
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