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Beta-blockers for heart failure with reduced, mid-range, and preserved ejection fraction: an individual patient-level analysis of double-blind randomized trials.

Cleland, JGF; Bunting, KV; Flather, MD; Altman, DG; Holmes, J; Coats, AJS; Manzano, L; McMurray, JJV; Ruschitzka, F; van Veldhuisen, DJ; et al. Cleland, JGF; Bunting, KV; Flather, MD; Altman, DG; Holmes, J; Coats, AJS; Manzano, L; McMurray, JJV; Ruschitzka, F; van Veldhuisen, DJ; von Lueder, TG; Böhm, M; Andersson, B; Kjekshus, J; Packer, M; Rigby, AS; Rosano, G; Wedel, H; Hjalmarson, Å; Wikstrand, J; Kotecha, D; Beta-blockers in Heart Failure Collaborative Group (2018) Beta-blockers for heart failure with reduced, mid-range, and preserved ejection fraction: an individual patient-level analysis of double-blind randomized trials. Eur Heart J, 39 (1). pp. 26-35. ISSN 1522-9645 https://doi.org/10.1093/eurheartj/ehx564
SGUL Authors: Rosano, Giuseppe Massimo Claudio

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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: Article
Additional Information: This is a pre-copyedited, author-produced version of an article accepted for publication in European Heart Journal following peer review. The version of record John G F Cleland, Karina V Bunting, Marcus D Flather, Douglas G Altman, Jane Holmes, Andrew J S Coats, Luis Manzano, John J V McMurray, Frank Ruschitzka, Dirk J van Veldhuisen, Thomas G von Lueder, Michael Böhm, Bert Andersson, John Kjekshus, Milton Packer, Alan S Rigby, Giuseppe Rosano, Hans Wedel, Åke Hjalmarson, John Wikstrand, Dipak Kotecha, Beta-blockers in Heart Failure Collaborative Group, 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, Volume 39, Issue 1, 01 January 2018, Pages 26–35 is available online at: https://doi.org/10.1093/eurheartj/ehx564.
Keywords: Atrial fibrillation, Beta-blockers, Ejection fraction, Heart failure, Mortality, Sinus rhythm, Beta-blockers in Heart Failure Collaborative Group, 1102 Cardiovascular Medicine And Haematology, Cardiovascular System & Hematology
SGUL Research Institute / Research Centre: Academic Structure > Molecular and Clinical Sciences Research Institute (MCS)
Journal or Publication Title: Eur Heart J
ISSN: 1522-9645
Language: eng
Dates:
DateEvent
1 January 2018Published
10 October 2017Published Online
17 September 2017Accepted
Publisher License: Publisher's own licence
Projects:
Project IDFunderFunder ID
CDF-2015-08-074Department of Healthhttp://dx.doi.org/10.13039/501100000276
PubMed ID: 29040525
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/111191
Publisher's version: https://doi.org/10.1093/eurheartj/ehx564

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