Beta-blockers don't improve heart failure, A-fib outcomes
Dipak Kotecha, Ph.D., from the University of Birmingham in the United Kingdom, and colleagues performed a meta-analysis of individual-patient data from 10 randomized controlled trials of the comparison of β-blockers versus placebo in heart failure.
The researchers found that, of the 18,254 patients assessed, 76 percent had sinus rhythm and 17 percent had atrial fibrillation at baseline. Over a mean follow-up of 1.5 years, the crude death rates were 16 percent (2,237 of 13,945) in patients with sinus rhythm and 21 percent (633 of 3,064) in patients with atrial fibrillation. There was a significant reduction in all-cause mortality in patients with sinus rhythm on β-blockers (hazard ratio, 0.73; 95 percent confidence interval, 0.67 to 0.80; P < 0.001), but not in patients with atrial fibrillation (hazard ratio, 0.97; 95 percent confidence interval, 0.83 to 1.14; P = 0.73), with a significant p value for interaction of baseline rhythm (P = 0.002). For all-cause mortality, β-blockers showed a lack of efficacy in all subgroups of atrial fibrillation, including age, sex, left ventricular ejection fraction, New York Heart Association class, heart rate, and baseline medical therapy.
"Based on our findings, β-blockers should not be used preferentially over other rate-control medications and not regarded as standard therapy to improve prognosis in patients with concomitant heart failure and atrial fibrillation," the authors write.
Several authors disclosed financial ties to pharmaceutical companies, including Menarini Farmaceutica Internazionale, which partially funded the study.
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