S Lee1, A Spencer. 1. Department of Pharmacy Practice, Medical University of South Carolina, Charleston, SC 29425, USA. leesj@musc.edu
Abstract
OBJECTIVE: The researchers reviewed published clinical trials and performed a meta-analysis to assess if therapy with adrenergic beta-antagonists (beta-blockers) reduces the risk of mortality in patients with systolic dysfunction. STUDY DESIGN: A systematic review was performed with meta-analysis where appropriate. Clinical trials were reviewed with respect to the quality of the research methods, including patient population and end points. Two independent reviewers calculated relative risk, relative risk reduction, absolute risk reduction, and number needed to treat for the total mortality end point reported in each trial. A meta-analysis was performed. DATA SOURCES: The study team searched pertinent indexing services and references from published articles for relevant literature. The selected clinical trials were randomized, double-blinded, and controlled, and included patients with systolic heart failure. Mortality was assessed as a primary or secondary end point. OUTCOMES MEASURED: The primary outcome was mortality. RESULTS: Statistically and clinically significant improvement, including a statistically significant reduction in mortality, has been noted in patients receiving therapy with either bisoprolol, carvedilol, or metoprolol. Pooled analysis revealed a statistically significant reduction in the risk of total mortality (odds ratio [OR]MH=0.66; 95% confidence interval [CI], 0.58-0.75) and sudden death (ORMH=0.61; 95% CI, 0.5-0.75) for patients receiving beta-blocker therapy. CONCLUSIONS: All patients with New York Heart Association class II and III heart failure should receive beta-blocker therapy with bisoprolol, carvedilol, or metoprolol. Additional clinical trials are ongoing and will provide further data on which patients receive the greatest benefit from therapy and which beta-blocker may be preferred.
OBJECTIVE: The researchers reviewed published clinical trials and performed a meta-analysis to assess if therapy with adrenergic beta-antagonists (beta-blockers) reduces the risk of mortality in patients with systolic dysfunction. STUDY DESIGN: A systematic review was performed with meta-analysis where appropriate. Clinical trials were reviewed with respect to the quality of the research methods, including patient population and end points. Two independent reviewers calculated relative risk, relative risk reduction, absolute risk reduction, and number needed to treat for the total mortality end point reported in each trial. A meta-analysis was performed. DATA SOURCES: The study team searched pertinent indexing services and references from published articles for relevant literature. The selected clinical trials were randomized, double-blinded, and controlled, and included patients with systolic heart failure. Mortality was assessed as a primary or secondary end point. OUTCOMES MEASURED: The primary outcome was mortality. RESULTS: Statistically and clinically significant improvement, including a statistically significant reduction in mortality, has been noted in patients receiving therapy with either bisoprolol, carvedilol, or metoprolol. Pooled analysis revealed a statistically significant reduction in the risk of total mortality (odds ratio [OR]MH=0.66; 95% confidence interval [CI], 0.58-0.75) and sudden death (ORMH=0.61; 95% CI, 0.5-0.75) for patients receiving beta-blocker therapy. CONCLUSIONS: All patients with New York Heart Association class II and III heart failure should receive beta-blocker therapy with bisoprolol, carvedilol, or metoprolol. Additional clinical trials are ongoing and will provide further data on which patients receive the greatest benefit from therapy and which beta-blocker may be preferred.
Authors: Randall S Stafford; Stephen M Davidson; Harriet Davidson; Heidi Miracle-McMahill; Sybil L Crawford; David Blumenthal Journal: Health Serv Res Date: 2003-04 Impact factor: 3.402