Contemporary use and implications of beta-blockers in patients with HFmrEF or HFpEF: the DELIVER Trial

Peikert, A. et al. (2024) Contemporary use and implications of beta-blockers in patients with HFmrEF or HFpEF: the DELIVER Trial. JACC: Heart Failure, 12(4), pp. 631-644. (doi: 10.1016/j.jchf.2023.09.007) (PMID:37767674)

Abstract

Background: Although beta-blockers are not recommended for the treatment of heart failure with preserved ejection fraction (HFpEF) according to the latest European Society of Cardiology and American Heart Association/American College of Cardiology/Heart Failure Society of America guidelines, these therapies remain commonly used for comorbidity management. There has been concern that beta-blockers may adversely influence clinical outcomes by limiting chronotropic response in HFpEF. Objectives: This study sought to examine the contemporary use and implications of beta-blockers in patients with heart failure with mildly reduced ejection fraction (HFmrEF) or HFpEF. Methods: In the DELIVER (Dapagliflozin Evaluation to Improve the Lives of Patients With Preserved Ejection Fraction Heart Failure) trial, a total of 6,263 patients with symptomatic heart failure (HF) with a left ventricular ejection fraction (LVEF) >40% were randomized to dapagliflozin or placebo across 20 countries. In this prespecified analysis, efficacy and safety outcomes were examined according to beta-blocker use at randomization. The primary outcome was cardiovascular death or worsening HF. Results: Overall, beta-blockers were used in 5,177 patients (83%), with wide variation by geographic region. Beta-blocker use was associated with a lower risk of the primary outcome in covariate-adjusted models (HR: 0.70; 95% CI: 0.60-0.83). Dapagliflozin consistently reduced the risk of the primary outcome in patients taking beta-blockers (HR: 0.82; 95% CI: 0.72-0.94) and in patients not taking beta-blockers (HR: 0.79; 95% CI: 0.61-1.03; Pinteraction = 0.85), with similar findings for key secondary endpoints. Adverse events were balanced between patients randomized to dapagliflozin and placebo, regardless of background beta-blocker use. Conclusions: In patients with HFmrEF or HFpEF who were enrolled in DELIVER, 4 out of 5 participants were treated with a beta-blocker. Beta-blocker use was not associated with a higher risk of worsening HF or cardiovascular death. Dapagliflozin consistently and safely reduced clinical events, irrespective of background beta-blocker use. (Dapagliflozin Evaluation to Improve the Lives of Patients With Preserved Ejection Fraction Heart Failure [DELIVER]; NCT03619213)

• Item Type: Articles
• Additional Information: The DELIVER trial was funded by Astra Zeneca.
• Keywords: heart failure with mildly reduced ejection fraction, heart failure with preserved ejection fraction, beta-blockers, SGLT2 inhibitors
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Jhund, Professor Pardeep and McMurray, Professor John
• Authors: Peikert, A., Bart, B. A., Vaduganathan, M., Claggett, B. L., Kulac, I. J., Kosiborod, M. N., Desai, A. S., Jhund, P. S., Lam, C. S.P., Inzucchi, S. E., Martinez, F. A., de Boer, R. A., Hernandez, A. F., Shah, S. J., Petersson, M., Langkilde, A. M., McMurray, J. J. V., Solomon, S. D., and Vardeny, O.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: JACC: Heart Failure
• Publisher: Elsevier
• ISSN: 2213-1779
• ISSN (Online): 2213-1787
• Published Online: 27 September 2023
• Copyright Holders: Copyright © 2023 The Authors
• First Published: First published in JACC: Heart Failure 12(4):631-644
• Publisher Policy: Reproduced under a Creative Commons license