Lars H. Lund, M.D., Ph.D., of the Karolinska Institutet, Stockholm, Sweden, and colleagues conducted a study to examine whether beta-blockers are associated with reduced mortality in heart failure patients with preserved ejection fraction (a measure of how well the left ventricle of the heart pumps with each contraction).The study appears in the November 19 issue of JAMA, a cardiovascular disease theme issue.
Up to half of patients with heart failure have normal or near-normal ejection fraction, termed heart failure with preserved ejection fraction (HFPEF). The risk of death in HFPEF may be as high as in heart failure with reduced ejection fraction (HFREF), but there is no proven therapy. Beta-blockers improve outcomes in HFREF and may be beneficial in HFPEF, but data are sparse and inconclusive, and beta-blockers are currently not indicated for treating HFPEF, according to background information in the article.
The researchers used data from the Swedish Heart Failure Registry, which includes 67 hospitals with inpatient and outpatient units and 95 outpatient primary care clinics in Sweden. This analysis included 41,976 patients, 19,083 patients with HFPEF. Of these, 8,244 were matched 2:1 based on age and beta-blocker use, yielding 5,496 treated and 2,748 untreated patients with HFPEF. Another analysis involved 22,893 patients with HFREF, of whom 6,081were matched, yielding 4,054 treated with beta-blockers and 2,027 untreated patients.
In the matched HFPEF cohort, 5-year survival was 45 percent vs 42 percent for treated vs untreated patients, with 2,279 (41 percent) vs 1,244 (45 percent) total deaths, and a seven percent reduction in the risk of death. Beta-blockers were not associated with reduced combined mortality or heart failure hospitalizations: 3,368 (61 percent) vs 1,753 (64 percent) total for first events. In the matched HFREF cohort, beta-blockers were associated with reduced mortality and also with reduced combined mortality or heart failure hospitalization.
"In patients with HFPEF, use of beta-blockers was associated with lower all-cause mortality but not with lower combined allcause mortality or heart failure hospitalization," the authors write. "Beta-blockers in HFPEF should be examined in a large randomized clinical trial."
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(doi:10.1001/jama.2014.15241; Available pre-embargo to the media at http://media.jamanetwork.com)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
Editorial: Searching for Treatments of Heart Failure with Preserved Ejection Fraction - Matching the Data to the Question
In an accompanying editorial, Susan Cheng, M.D., M.P.H., and Marc A. Pfeffer, M.D., Ph.D., of Brigham and Women's Hospital, Boston, write that by design, administrative databases, such as the one used in this study, offer limited ability to provide complete information about potentially important confounders.
"Thus, an attempt to use administrative data to probe the potential efficacy of a therapy is a mismatch of the data to the question. However, for most questions in medicine, only incomplete data are available to guide diagnostic and therapeutic decisions, and observational studies may have a role in assisting with treatment options. As the authors also conclude, more definitive information about whether beta-blocker therapy is effective for preventing important outcomes in HFPEF requires well-designed and well conducted randomized clinical trials."
(doi:10.1001/jama.2014.15358; Available pre-embargo to the media at http://media.jamanetwork.com)
Editor's Note: Please see the article for additional information, including financial disclosures, funding and support, etc.
Journal
JAMA