Michiel Rienstra1, Kevin Damman1, Bart A Mulder1, Isabelle C Van Gelder1, John J V McMurray2, Dirk J Van Veldhuisen3. 1. Department of Cardiology, University of Groningen, University Medical Center Groningen, the Netherlands. 2. BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom. 3. Department of Cardiology, University of Groningen, University Medical Center Groningen, the Netherlands. Electronic address: d.j.van.veldhuisen@umcg.nl.
Abstract
OBJECTIVES: The purpose of this study was to analyze the effect of beta blockade on outcome in patients with heart failure (HF) and atrial fibrillation (AF). BACKGROUND: Beta-blockers are widely used in patients with HF and AF. Recommendation in current HF guidelines, however, is based on populations in which the most patients had sinus rhythm. Whether beta-blockers are as useful in AF is uncertain. METHODS: Studies were included that investigated the effect of placebo-controlled, randomized beta-blocker therapy in patients with AF at baseline and HF with reduced systolic left ventricular ejection fraction (LVEF) <40%. RESULTS: We identified 4 studies, which enrolled 8,680 patients with HF, and 1,677 of them had AF (19%; mean 68 years of age; 30% women); there were 842 patients treated with beta-blocker, and 835 with placebo. In AF patients, beta-blockade did not reduce mortality (odds ratio [OR]: 0.86 [95% confidence interval (CI): 0.66 to 1.13]; p = 0.28), while in sinus rhythm patients, there was a significant reduction (OR: 0.63 [95% CI: 0.54 to 0.73]; p < 0.0001). Interaction analysis showed significant interaction of the effects of beta-blocker therapy in AF versus that in sinus rhythm (p = 0.048). By meta-regression analysis, we did not find confounding by all relevant covariates. Beta-blocker therapy was not associated with a reduction in HF hospitalizations in AF (OR: 1.11 [95% CI: 0.85 to 1.47]; p = 0.44), in contrast to sinus rhythm (OR: 0.58 [95% CI: 0.49 to 0.68]; p < 0.0001). There was a significant interaction of the effects of beta-blocker therapy in AF versus that in sinus rhythm (p < 0.001). CONCLUSIONS: Our findings suggest that the effect of beta-blockers on outcome in HF patients with reduced systolic LVEF who have AF is less than in those who have sinus rhythm.
OBJECTIVES: The purpose of this study was to analyze the effect of beta blockade on outcome in patients with heart failure (HF) and atrial fibrillation (AF). BACKGROUND: Beta-blockers are widely used in patients with HF and AF. Recommendation in current HF guidelines, however, is based on populations in which the most patients had sinus rhythm. Whether beta-blockers are as useful in AF is uncertain. METHODS: Studies were included that investigated the effect of placebo-controlled, randomized beta-blocker therapy in patients with AF at baseline and HF with reduced systolic left ventricular ejection fraction (LVEF) <40%. RESULTS: We identified 4 studies, which enrolled 8,680 patients with HF, and 1,677 of them had AF (19%; mean 68 years of age; 30% women); there were 842 patients treated with beta-blocker, and 835 with placebo. In AFpatients, beta-blockade did not reduce mortality (odds ratio [OR]: 0.86 [95% confidence interval (CI): 0.66 to 1.13]; p = 0.28), while in sinus rhythm patients, there was a significant reduction (OR: 0.63 [95% CI: 0.54 to 0.73]; p < 0.0001). Interaction analysis showed significant interaction of the effects of beta-blocker therapy in AF versus that in sinus rhythm (p = 0.048). By meta-regression analysis, we did not find confounding by all relevant covariates. Beta-blocker therapy was not associated with a reduction in HF hospitalizations in AF (OR: 1.11 [95% CI: 0.85 to 1.47]; p = 0.44), in contrast to sinus rhythm (OR: 0.58 [95% CI: 0.49 to 0.68]; p < 0.0001). There was a significant interaction of the effects of beta-blocker therapy in AF versus that in sinus rhythm (p < 0.001). CONCLUSIONS: Our findings suggest that the effect of beta-blockers on outcome in HF patients with reduced systolic LVEF who have AF is less than in those who have sinus rhythm.
Authors: Stephen J Greene; Gregg C Fonarow; Scott D Solomon; Haris P Subacius; Andrew P Ambrosy; Muthiah Vaduganathan; Aldo P Maggioni; Michael Böhm; Eldrin F Lewis; Faiez Zannad; Javed Butler; Mihai Gheorghiade Journal: Eur J Heart Fail Date: 2016-10-17 Impact factor: 15.534
Authors: Bart A Mulder; Kevin Damman; Dirk J Van Veldhuisen; Isabelle C Van Gelder; Michiel Rienstra Journal: Clin Cardiol Date: 2017-05-17 Impact factor: 2.882
Authors: Hanna Fröhlich; Lorella Torres; Tobias Täger; Dieter Schellberg; Anna Corletto; Syed Kazmi; Kevin Goode; Morten Grundtvig; Torstein Hole; Hugo A Katus; John G F Cleland; Dan Atar; Andrew L Clark; Stefan Agewall; Lutz Frankenstein Journal: Clin Res Cardiol Date: 2017-04-22 Impact factor: 5.460
Authors: Liang-Han Ling; Peter M Kistler; Jonathan M Kalman; Richard J Schilling; Ross J Hunter Journal: Nat Rev Cardiol Date: 2015-12-10 Impact factor: 32.419
Authors: Rosita Zakeri; Barry A Borlaug; Steven E McNulty; Selma F Mohammed; Gregory D Lewis; Marc J Semigran; Anita Deswal; Martin LeWinter; Adrian F Hernandez; Eugene Braunwald; Margaret M Redfield Journal: Circ Heart Fail Date: 2013-10-25 Impact factor: 8.790