Gai-Gai Ma1, Quan Fang2, Feng-Xia Wang3. 1. Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China. 2. Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China. 18800161900@163.com. 3. Department of Cardiology,People's Hospital of Xinjiang UygurAutonomous Region, Urumqi, Xinjiang, China.
Abstract
BACKGROUND: Beta-blockers (BB) are the cornerstone of therapy for heart failure (HF); however, the effects of these drugs on the prognosis of patients with concomitant atrial fibrillation (AF) remain controversial. The objective of this meta-analysis was to evaluate the efficacy of BB on mortality in HF coexisting with AF. METHODS: A systematic search of PubMed, Embase and the Cochrane Library databases was conducted. Observational cohort studies and randomized controlled trials reporting outcomes of mortality or HF hospitalizations for patients with HF and AF, being assigned to BB treatment. A non-BB group was also included. RESULTS: A total of 8 clinical studies (5 randomized controlled trials and 3 observational cohort studies) involving 34197 patients were included in the analysis. The pooled analysis demonstrated that BB treatment was associated with a 22% reduction in relative risk of all-cause mortality in patients with HF and AF (RR: 0.78; 95% CI 0.71-0.86; p < 0.00001; I2 = 27%). The pooled analysis of 5 studies reported the outcome of HF hospitalization (2774 patients) which showed that BB therapy was not associated with a reduction of HF hospitalizations (RR: 0.94; 95% CI 0.79-1.11; p = 0.46; I2 = 38%). CONCLUSIONS: Meta-analysis suggests the potential mortality benefit of BB in patients with HF and AF. It was concluded herein that it is premature to deny patients with AF and HF to receive BB therapy considering current evidence.
BACKGROUND: Beta-blockers (BB) are the cornerstone of therapy for heart failure (HF); however, the effects of these drugs on the prognosis of patients with concomitant atrial fibrillation (AF) remain controversial. The objective of this meta-analysis was to evaluate the efficacy of BB on mortality in HF coexisting with AF. METHODS: A systematic search of PubMed, Embase and the Cochrane Library databases was conducted. Observational cohort studies and randomized controlled trials reporting outcomes of mortality or HF hospitalizations for patients with HF and AF, being assigned to BB treatment. A non-BB group was also included. RESULTS: A total of 8 clinical studies (5 randomized controlled trials and 3 observational cohort studies) involving 34197 patients were included in the analysis. The pooled analysis demonstrated that BB treatment was associated with a 22% reduction in relative risk of all-cause mortality in patients with HF and AF (RR: 0.78; 95% CI 0.71-0.86; p < 0.00001; I2 = 27%). The pooled analysis of 5 studies reported the outcome of HF hospitalization (2774 patients) which showed that BB therapy was not associated with a reduction of HF hospitalizations (RR: 0.94; 95% CI 0.79-1.11; p = 0.46; I2 = 38%). CONCLUSIONS: Meta-analysis suggests the potential mortality benefit of BB in patients with HF and AF. It was concluded herein that it is premature to deny patients with AF and HF to receive BB therapy considering current evidence.
Authors: J A Joglar; A P Acusta; N H Shusterman; K Ramaswamy; R C Kowal; S J Barbera; M H Hamdan; R L Page Journal: Am Heart J Date: 2001-09 Impact factor: 4.749
Authors: Bouwe P Krijthe; Anton Kunst; Emelia J Benjamin; Gregory Y H Lip; Oscar H Franco; Albert Hofman; Jacqueline C M Witteman; Bruno H Stricker; Jan Heeringa Journal: Eur Heart J Date: 2013-07-30 Impact factor: 29.983
Authors: Paul A Heidenreich; Nancy M Albert; Larry A Allen; David A Bluemke; Javed Butler; Gregg C Fonarow; John S Ikonomidis; Olga Khavjou; Marvin A Konstam; Thomas M Maddox; Graham Nichol; Michael Pham; Ileana L Piña; Justin G Trogdon Journal: Circ Heart Fail Date: 2013-04-24 Impact factor: 8.790
Authors: Bart A Mulder; Dirk J Van Veldhuisen; Harry J G M Crijns; Jan G P Tijssen; Hans L Hillege; Marco Alings; Michiel Rienstra; Hessel F Groenveld; Maarten P Van den Berg; Isabelle C Van Gelder Journal: Eur J Heart Fail Date: 2013-06-12 Impact factor: 15.534
Authors: Dipak Kotecha; Jane Holmes; Henry Krum; Douglas G Altman; Luis Manzano; John G F Cleland; Gregory Y H Lip; Andrew J S Coats; Bert Andersson; Paulus Kirchhof; Thomas G von Lueder; Hans Wedel; Giuseppe Rosano; Marcelo C Shibata; Alan Rigby; Marcus D Flather Journal: Lancet Date: 2014-09-02 Impact factor: 79.321
Authors: Michiel Rienstra; Kevin Damman; Bart A Mulder; Isabelle C Van Gelder; John J V McMurray; Dirk J Van Veldhuisen Journal: JACC Heart Fail Date: 2013-02-04 Impact factor: 12.035
Authors: Robert J H Miller; Jonathan G Howlett; Michael H Chiu; Danielle A Southern; Merril Knudtson; Stephen B Wilton Journal: Open Heart Date: 2016-12-23