Hanna Fröhlich1, Lorella Torres1, Tobias Täger1, Dieter Schellberg1, Anna Corletto1, Syed Kazmi2, Kevin Goode3, Morten Grundtvig4, Torstein Hole5,6, Hugo A Katus1, John G F Cleland7,8, Dan Atar9, Andrew L Clark2, Stefan Agewall9, Lutz Frankenstein10. 1. Department of Cardiology, Angiology and Pulmology, University Hospital Heidelberg, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany. 2. Castle Hill Hospital, Hull York Medical School, Hull, UK. 3. Hull York Medical School, University of Hull, Hull, UK. 4. Medical Department, Innlandet Hospital Trust Division Lillehammer, Lillehammer, Norway. 5. Medical Faculty, Norwegian University of Science and Technology (NTNU), Trondheim, Norway. 6. Medical Clinic, Helse Møre and Romsdal HF, Ålesund, Norway. 7. National Heart and Lung Institute, Royal Brompton, Harefield Hospitals, Imperial College, London, UK. 8. Robertson Centre for Biostatistics & Clinical Trials, Glasgow, UK. 9. Department of Cardiology, Oslo University Hospital, Ulleval and Institute of Clinical Sciences, University of Oslo, Oslo, Norway. 10. Department of Cardiology, Angiology and Pulmology, University Hospital Heidelberg, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany. Lutz.Frankenstein@med.uni-heidelberg.de.
Abstract
AIMS: Beta-blockers are recommended for the treatment of chronic heart failure (CHF). However, it is disputed whether beta-blockers exert a class effect or whether there are differences in efficacy between agents. METHODS AND RESULTS: 6010 out-patients with stable CHF and a reduced left ventricular ejection fraction prescribed either bisoprolol, carvedilol or metoprolol succinate were identified from three registries in Norway, England, and Germany. In three separate matching procedures, patients were individually matched with respect to both dose equivalents and the respective propensity scores for beta-blocker treatment. During a follow-up of 26,963 patient-years, 302 (29.5%), 637 (37.0%), and 1232 (37.7%) patients died amongst those prescribed bisoprolol, carvedilol, and metoprolol, respectively. In univariable analysis of the general sample, bisoprolol and carvedilol were both associated with lower mortality as compared with metoprolol succinate (HR 0.80, 95% CI 0.71-0.91, p < 0.01, and HR 0.86, 95% CI 0.78-0.94, p < 0.01, respectively). Patients prescribed bisoprolol or carvedilol had similar mortality (HR 0.94, 95% CI 0.82-1.08, p = 0.37). However, there was no significant association between beta-blocker choice and all-cause mortality in any of the matched samples (HR 0.90; 95% CI 0.76-1.06; p = 0.20; HR 1.10, 95% CI 0.93-1.31, p = 0.24; and HR 1.08, 95% CI 0.95-1.22, p = 0.26 for bisoprolol vs. carvedilol, bisoprolol vs. metoprolol succinate, and carvedilol vs. metoprolol succinate, respectively). Results were confirmed in a number of important subgroups. CONCLUSION: Our results suggest that the three beta-blockers investigated have similar effects on mortality amongst patients with CHF.
AIMS: Beta-blockers are recommended for the treatment of chronic heart failure (CHF). However, it is disputed whether beta-blockers exert a class effect or whether there are differences in efficacy between agents. METHODS AND RESULTS: 6010 out-patients with stable CHF and a reduced left ventricular ejection fraction prescribed either bisoprolol, carvedilol or metoprolol succinate were identified from three registries in Norway, England, and Germany. In three separate matching procedures, patients were individually matched with respect to both dose equivalents and the respective propensity scores for beta-blocker treatment. During a follow-up of 26,963 patient-years, 302 (29.5%), 637 (37.0%), and 1232 (37.7%) patients died amongst those prescribed bisoprolol, carvedilol, and metoprolol, respectively. In univariable analysis of the general sample, bisoprolol and carvedilol were both associated with lower mortality as compared with metoprolol succinate (HR 0.80, 95% CI 0.71-0.91, p < 0.01, and HR 0.86, 95% CI 0.78-0.94, p < 0.01, respectively). Patients prescribed bisoprolol or carvedilol had similar mortality (HR 0.94, 95% CI 0.82-1.08, p = 0.37). However, there was no significant association between beta-blocker choice and all-cause mortality in any of the matched samples (HR 0.90; 95% CI 0.76-1.06; p = 0.20; HR 1.10, 95% CI 0.93-1.31, p = 0.24; and HR 1.08, 95% CI 0.95-1.22, p = 0.26 for bisoprolol vs. carvedilol, bisoprolol vs. metoprolol succinate, and carvedilol vs. metoprolol succinate, respectively). Results were confirmed in a number of important subgroups. CONCLUSION: Our results suggest that the three beta-blockers investigated have similar effects on mortality amongst patients with CHF.
Entities:
Keywords:
Beta-blocker; Effectiveness; Heart failure with reduced ejection fraction; Survival
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