Abstract
Background
β-Blockers have an uncertain effect in heart failure with a preserved ejection fraction
of 50% or higher (heart failure with preserved ejection fraction [HFpEF]).
Methods and Results
We included patients with HFpEF from the Swedish Heart Failure Registry (SwedeHF)
enrolled from 2011 through 2018. In a 2:1 propensity-score matched analysis (β-blocker
use vs nonuse), we assessed the primary outcome first HF hospitalization, the coprimary
outcome cardiovascular (CV) death, and the secondary outcomes of all-cause hospitalization
and all-cause death. We performed intention-to-treat and a per-protocol consistency
analyses. There were a total of 14,434 patients (median age 79 years, IQR 71–85 years,
51% women); 80% were treated with a β-blocker at baseline. Treated patients were younger
and had higher rates of atrial fibrillation and coronary artery disease, and higher
N-terminal pro-B-type natriuretic peptide levels. In the 4412:2206 patient matched
cohort, at 5 years, 42% (95% CI 40%–44%) vs 44% (95% CI 41%–47%) had a HF admission
and 38% (IQR 36%–40%) vs 40% (IQR 36%–42%) died from CV causes. In the intention-to-treat
analysis, β-blocker use was not associated with HF admissions (hazard ratio 0.95 [95%
CI 0.87–1.05, P = .31]) or CV death (hazard ratio 0.94 [95% CI 0.85–1.03, P = .19]). In the subgroup analyses, men seemed to have a more favorable association
between β-blockers and outcomes than did women. There were no associations between
β-blocker use and secondary outcomes.
Conclusions
In patients with HFpEF, β-blocker use is common but not associated with changes in
HF hospitalization or cardiovascular mortality. In the absence of a strong rational
and randomized control trials the case for β-blockers in HFpEF remains inconclusive.
Bullet points
● The effect of β-blockers with heart failure with preserved ejection fraction of
50% or greater is uncertain.● In a propensity score–matched heart failure with preserved
ejection fraction analysis in the SwedeHF registry, β-blockers were not associated
with a change in risk for heart failure admissions or cardiovascular deaths.
Lay summary
The optimal treatment for heart failure with a preserved pump function remains unknown.
Despite the lack of scientific studies, β-blockers are very commonly used. When matching
patients with a similar risk profile in a large heart failure registry, the use of
β-blockers for the treatment of heart failure with a preserved pump function was not
associated with any changes in heart failure hospital admissions or cardiovascular
death.
Graphical Abstract
Graphical Abstract
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Article info
Publication history
Published online: May 07, 2021
Accepted:
April 14,
2021
Received in revised form:
April 7,
2021
Received:
February 12,
2021
Footnotes
Supported by the EU/EFPIA Innovative Medicines Initiative 2 Joint Undertaking [email protected] grant [n° 116074]; the Swedish Research Council [grant 523-2014-2336]; and the Swedish Heart Lung Foundation [grants 20150557 and 20170841] in the form of grants to LHL. Dr. Meyer was supported by grant R01 HL-122744 from the National Institutes of Health.
Identification
Copyright
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