Abstract
BackgroundEffects of beta-blockers on the prognosis of the heart failure patients with preserved ejection fraction (HFpEF) remain controversial. The aim of this meta-analysis was to determine the impact of beta-blockers on mortality and hospitalization in the patients with HFpEF.MethodsA search of MEDLINE, EMBASE, and the Cochrane Library databases from 2005 to June 2013 was conducted. Clinical studies reporting outcomes of mortality and/or hospitalization for patients with HFpEF (EF ≥ 40%), being assigned to beta-blockers treatment and non-beta-blockers control group were included.ResultsA total of 12 clinical studies (2 randomized controlled trials and 10 observational studies) involving 21,206 HFpEF patients were included for this meta-analysis. The pooled analysis demonstrated that beta-blocker exposure was associated with a 9% reduction in relative risk for all-cause mortality in patients with HFpEF (95% CI: 0.87 – 0.95; P < 0.001). Whereas, the all-cause hospitalization, HF hospitalization and composite outcomes (mortality and hospitalization) were not affected by this treatment (P = 0.26, P = 0.97, and P = 0.88 respectively).ConclusionsThe beta-blockers treatment for the patients with HFpEF was associated with a lower risk of all-cause mortality, but not with a lower risk of hospitalization. These finding were mainly obtained from observational studies, and further investigations are needed to make an assertion.
Highlights
Epidemiological data reveals that approximately 50% of chronic heart failure (HF) patients have normal or only mildly impaired left ventricular ejection fraction (EF), which is referred to as the HF with preserved EF (HFpEF) patients [1]
Some observational studies demonstrated the beta-blockers treatment decreased the risks of all-cause mortality in the heart failure patients with preserved ejection fraction (HFpEF) patients [7,8,9], while the reduction was not observed in the sub-analysis of SENIORS trial [10] and JDHF trial [11]
A previous meta-analysis addressed the effects of pharmacotherapies in the HFpEF patients [13], they used the threshold of an EF $ 35% as the diagnosis of the HFpEF patients, which is usually not considered ‘‘preserved.’’ In addition, several studies have been published since the previous meta-analysis was performed
Summary
Epidemiological data reveals that approximately 50% of chronic heart failure (HF) patients have normal or only mildly impaired left ventricular ejection fraction (EF), which is referred to as the HF with preserved EF (HFpEF) patients [1]. The prognosis of HFpEF patients remains poor, which is similar to that of HF patients with reduced ejection fraction (HFrEF) [3]. Some observational studies demonstrated the beta-blockers treatment decreased the risks of all-cause mortality in the HFpEF patients [7,8,9], while the reduction was not observed in the sub-analysis of SENIORS trial [10] and JDHF trial [11]. Effects of beta-blockers on the prognosis of the heart failure patients with preserved ejection fraction (HFpEF) remain controversial.
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