Jeness Campodonico1, Massimo Piepoli2, Francesco Clemenza3, Alice Bonomi1, Stefania Paolillo4, Elisabetta Salvioni1, Ugo Corrà5, Simone Binno2, Fabrizio Veglia1, Rocco Lagioia6, Gianfranco Sinagra7, Gaia Cattadori8, Angela B Scardovi9, Marco Metra10, Michele Senni11, Domenico Scrutinio6, Rosa Raimondo12, Michele Emdin13, Damiano Magrì14, Gianfranco Parati15, Federica Re16, Mariantonietta Cicoira17, Chiara Minà3, Giuseppe Limongelli18, Michele Correale19, Maria Frigerio20, Maurizio Bussotti21, Enrico Perna20, Elisa Battaia22, Marco Guazzi23, Roberto Badagliacca24, Andrea Di Lenarda25, Aldo Maggioni26, Claudio Passino27, Susanna Sciomer24, Giuseppe Pacileo18, Massimo Mapelli1, Carlo Vignati1, Carlo Lombardi10, Pasquale Perrone Filardi4, Piergiuseppe Agostoni28. 1. Centro Cardiologico Monzino, IRCCS, Milano, Italy. 2. UOC Cardiologia, G da Saliceto Hospital, Piacenza, Italy. 3. Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation IRCCS - ISMETT, Palermo, Italy. 4. Department of Advanced Biomedical Sciences, Federico II University of Naples, Italy. 5. Divisione di Cardiologia Riabilitativa, Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Veruno, Veruno, Italy. 6. Division of Cardiology, "S. Maugeri" Foundation, IRCCS, Institute of Cassano Murge, Bari, Italy. 7. Cardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy. 8. Unità Operativa Cardiologia Riabilitativa, Multimedica IRCCS, Milano, Italy. 9. Cardiology Division, Santo Spirito Hospital, Roma, Italy. 10. Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, Public Health, University of Brescia, Brescia, Italy. 11. Department of Cardiology, Heart Failure and Heart Transplant Unit, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy. 12. Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Tradate, Italy. 13. Fondazione Gabriele Monasterio, CNR-Regione Toscana, Pisa, Italy; Life Science Institute, Scuola Superiore Sant'Anna, Pisa, Italy. 14. Department of Clinical and Molecular Medicine, Azienda Ospedaliera Sant'Andrea, "Sapienza" Università degli Studi di Roma, Roma, Italy. 15. Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy; Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano, Milan, Italy. 16. Cardiology Division, Cardiac Arrhythmia Center, Cardiomyopathies Unit, San Camillo-Forlanini Hospital, Roma, Italy. 17. Section of Cardiology, Department of Medicine, University of Verona, Verona, Italy. 18. Cardiologia SUN, Ospedale Monaldi (Azienda dei Colli), Seconda Università di Napoli, Napoli, Italy. 19. Department of Cardiology, University of Foggia, Foggia, Italy. 20. Dipartimento Cardiologico "A. De Gasperis", Ospedale Cà Granda- A.O. Niguarda, Milano, Italy. 21. Cardiac Rehabilitation Unit, Fondazione Salvatore Maugeri, IRCCS, Scientific Institute of Milan, Milan, Italy. 22. Department of Cardiology, S. Chiara Hospital, Trento, Italy. 23. Cardiology University Department, Heart Failure Unit and Cardiopulmonary Laboratory, IRCCS Policlinico San Donato, San Donato Milano, Italy. 24. Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesiologiche e Geriatriche, "Sapienza", Rome University, Rome, Italy. 25. Cardiovascular Center, Health Authority no 1, University of Trieste, Trieste, Italy. 26. ANMCO Research Center, Firenze, Italy. 27. Fondazione Salvatore Maugeri, IRCCS, Istituto Scientifico di Tradate, Italy; Fondazione Gabriele Monasterio, CNR-Regione Toscana, Pisa, Italy. 28. Centro Cardiologico Monzino, IRCCS, Milano, Italy; Dept. of Clinical Sciences and Community Health, Cardiovascular Section, University of Milano, Milano, Italy. Electronic address: piergiuseppe.agostoni@unimi.it.
Abstract
BACKGROUND: The usefulness of β-blockers in heart failure (HF) patients with permanent atrial fibrillation (AF) has been questioned. METHODS AND RESULTS: We analyzed data from HF patients (958 patients (801 males, 84%, age 67 ± 11 years)) with AF enrolled in the MECKI score database. We evaluated prognosis (composite of cardiovascular death, urgent heart transplant, or left ventricular assist device) of patients receiving β-blockers (n = 777, 81%) vs. those not treated with β-blockers (n = 181, 19%). We also analyzed the role β1-selectivity and the role of daily β-blocker dose. To account for different HF severity, Kaplan-Meier survival curves were normalized for relevant confounding factors and for treatment strategies. Dose was available in 629 patients. Median follow-up was 1312 (577-2304) days in the entire population, 1203 (614-2420) and 1325 (569-2300) days in patients not receiving and receiving β-blockers. 224 (23%, 54/1000 events/year), 163 (21%, 79/1000 events/year), and 61 (34%, 49/1000 events/year) events were recorded, respectively. At 10-year patients treated with β-blockers had a better outcome (HR 0.447, p < 0.01) with no effects as regards β1selective drugs (53%) vs. β1-β2 blockers (47%). Survival improved in parallel with β-blocker dose increase (HR 0.296, 0.496, 0.490 for the high, medium, and low dose vs. no β-blockers, p < 0.0001). CONCLUSION: HF patients with AF taking a β-blocker have a better outcome (with a survival improvement in parallel with daily dose but no differences as regards β1 selectivity) but this does not mean that β-blockers improve outcomes in these patients as we cannot control for all the potential confounders associated with β-blocker use.
BACKGROUND: The usefulness of β-blockers in heart failure (HF) patients with permanent atrial fibrillation (AF) has been questioned. METHODS AND RESULTS: We analyzed data from HF patients (958 patients (801 males, 84%, age 67 ± 11 years)) with AF enrolled in the MECKI score database. We evaluated prognosis (composite of cardiovascular death, urgent heart transplant, or left ventricular assist device) of patients receiving β-blockers (n = 777, 81%) vs. those not treated with β-blockers (n = 181, 19%). We also analyzed the role β1-selectivity and the role of daily β-blocker dose. To account for different HF severity, Kaplan-Meier survival curves were normalized for relevant confounding factors and for treatment strategies. Dose was available in 629 patients. Median follow-up was 1312 (577-2304) days in the entire population, 1203 (614-2420) and 1325 (569-2300) days in patients not receiving and receiving β-blockers. 224 (23%, 54/1000 events/year), 163 (21%, 79/1000 events/year), and 61 (34%, 49/1000 events/year) events were recorded, respectively. At 10-year patients treated with β-blockers had a better outcome (HR 0.447, p < 0.01) with no effects as regards β1selective drugs (53%) vs. β1-β2 blockers (47%). Survival improved in parallel with β-blocker dose increase (HR 0.296, 0.496, 0.490 for the high, medium, and low dose vs. no β-blockers, p < 0.0001). CONCLUSION: HF patients with AF taking a β-blocker have a better outcome (with a survival improvement in parallel with daily dose but no differences as regards β1 selectivity) but this does not mean that β-blockers improve outcomes in these patients as we cannot control for all the potential confounders associated with β-blocker use.
Authors: Paul A Heidenreich; Gregg C Fonarow; Khadijah Breathett; Corrine Y Jurgens; Barbara A Pisani; Bunny J Pozehl; John A Spertus; Kenneth G Taylor; Jennifer T Thibodeau; Clyde W Yancy; Boback Ziaeian Journal: Circ Cardiovasc Qual Outcomes Date: 2020-11-02
Authors: Paul A Heidenreich; Gregg C Fonarow; Khadijah Breathett; Corrine Y Jurgens; Barbara A Pisani; Bunny J Pozehl; John A Spertus; Kenneth G Taylor; Jennifer T Thibodeau; Clyde W Yancy; Boback Ziaeian Journal: J Am Coll Cardiol Date: 2020-11-02 Impact factor: 24.094