Saurav Chatterjee1, Jacob A Udell2, Partha Sardar3, Edgar Lichstein4, John J Ryan5. 1. Department of Cardiovascular Diseases, St Luke's-Roosevelt Hospital of the Mount Sinai Health System, New York, New York, USA. 2. Women's College Research Institute and Cardiovascular Division, Department of Medicine, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada. 3. Department of Cardiology, Texas Tech University Health Sciences Center, El Paso, Texas, USA. 4. Department of Medicine, Maimonides Medical Center and SUNY Downstate, Brooklyn, New York, USA. 5. Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah, USA. Electronic address: john.ryan@hsc.utah.edu.
Abstract
BACKGROUND: There is a concern about geographical region heterogeneity regarding clinical benefit of β-blocker (BB) therapy in heart failure with reduced ejection fraction (HFrEF). This study sought to compare benefits of BB use within randomized controlled trials (RCTs) that enrolled patients with HFrEF from North America (NA) compared with other regions of the world (ROW). METHODS: We conducted a meta-analysis using MEDLINE, EMBASE, Cochrane Library, Web of Science, and Scopus (inceptions-December 2012) of BB RCTs stratified according to NA vs ROW. The primary end point was all-cause mortality and secondary end points were cardiovascular death, sudden death, death due to pump failure, and premature drug discontinuation. Summary odds ratios (ORs) and 95% confidence intervals (CIs) for each outcome were calculated with interaction terms for region. Two-sided P values were calculated with P < 0.05 considered significant. RESULTS: The analysis included 16 RCTs with 14,452 patients; 7 trials were conducted in NA and 9 trials in ROW with follow-up durations of 3-58 months. All-cause mortality was consistently reduced in NA (OR, 0.82; 95% CI, 0.71-0.96; P = 0.01) and ROW (OR, 0.76; 95% CI, 0.69-0.84; P < 0.001; P-interaction = 0.40). Overall and according to region, all secondary end points including premature drug discontinuation were also less with BB therapy (P-interactions all ≥ 0.10). CONCLUSIONS: For the regions represented in the included trials, there is no evidence to suggest that geographic region is a significant moderator of clinical outcomes with BB therapy in HFrEF patients.
BACKGROUND: There is a concern about geographical region heterogeneity regarding clinical benefit of β-blocker (BB) therapy in heart failure with reduced ejection fraction (HFrEF). This study sought to compare benefits of BB use within randomized controlled trials (RCTs) that enrolled patients with HFrEF from North America (NA) compared with other regions of the world (ROW). METHODS: We conducted a meta-analysis using MEDLINE, EMBASE, Cochrane Library, Web of Science, and Scopus (inceptions-December 2012) of BB RCTs stratified according to NA vs ROW. The primary end point was all-cause mortality and secondary end points were cardiovascular death, sudden death, death due to pump failure, and premature drug discontinuation. Summary odds ratios (ORs) and 95% confidence intervals (CIs) for each outcome were calculated with interaction terms for region. Two-sided P values were calculated with P < 0.05 considered significant. RESULTS: The analysis included 16 RCTs with 14,452 patients; 7 trials were conducted in NA and 9 trials in ROW with follow-up durations of 3-58 months. All-cause mortality was consistently reduced in NA (OR, 0.82; 95% CI, 0.71-0.96; P = 0.01) and ROW (OR, 0.76; 95% CI, 0.69-0.84; P < 0.001; P-interaction = 0.40). Overall and according to region, all secondary end points including premature drug discontinuation were also less with BB therapy (P-interactions all ≥ 0.10). CONCLUSIONS: For the regions represented in the included trials, there is no evidence to suggest that geographic region is a significant moderator of clinical outcomes with BB therapy in HFrEF patients.
Authors: John J Ryan; Jessica Huston; Shelby Kutty; Nathan D Hatton; Lindsay Bowman; Lian Tian; Julia E Herr; Amer M Johri; Stephen L Archer Journal: Can J Cardiol Date: 2015-01-29 Impact factor: 5.223
Authors: Søren Lund Kristensen; Felipe Martinez; Pardeep S Jhund; Juan Luis Arango; Jan Bĕlohlávek; Sergey Boytsov; Walter Cabrera; Efrain Gomez; Albert A Hagège; Jun Huang; Songsak Kiatchoosakun; Kee-Sik Kim; Iván Mendoza; Michele Senni; Iain B Squire; Dragos Vinereanu; Raymond Ching-Chiew Wong; Jianjian Gong; Martin P Lefkowitz; Adel R Rizkala; Jean L Rouleau; Victor C Shi; Scott D Solomon; Karl Swedberg; Michael R Zile; Milton Packer; John J V McMurray Journal: Eur Heart J Date: 2016-06-28 Impact factor: 29.983