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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

Artikel i vetenskaplig tidskrift
Författare J. G. F. Cleland
K. V. Bunting
M. D. Flather
D. G. Altman
J. Holmes
A. J. S. Coats
L. Manzano
J. J. V. McMurray
F. Ruschitzka
D. J. van Veldhuisen
T. G. von Lueder
M. Bohm
Bert Andersson
J. Kjekshus
M. Packer
A. S. Rigby
G. Rosano
Hans Wedel
Åke Hjalmarson
John Wikstrand
D. Kotecha
Publicerad i European Heart Journal
Volym 39
Nummer/häfte 1
Sidor 26-35
ISSN 0195-668X
Publiceringsår 2018
Publicerad vid Wallenberglaboratoriet
Institutionen för medicin, avdelningen för molekylär och klinisk medicin
Institutionen för medicin, avdelningen för samhällsmedicin och folkhälsa, enheten för hälsometri
Sidor 26-35
Språk en
Länkar dx.doi.org/10.1093/eurheartj/ehx564
Ämnesord Heart failure, Ejection fraction, Beta-blockers, Mortality, Sinus rhythm, Atrial fibrillation, cardiac resynchronization therapy, atrial-fibrillation, clinical-trials, merit-hf, carvedilol, echocardiography, metaanalysis, metoprolol, outcomes, intervention, Cardiovascular System & Cardiology
Ämneskategorier Kardiologi

Sammanfattning

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. Conculations 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%.

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