Beta-Blockers vs. Reduced Heart Rate in HF Patients

In heart failure patients, higher doses of beta-blockers may be associated with a significant reduction in all-cause hospitalization and all-cause death compared to reduced heart rate, according to a study presented Sept. 26 at the Heart Failure Society of America’s Annual Scientific Meeting, and simultaneously published in JACC: Heart Failure.

The study, led by Mona Fiuzat, PharmD, FACC, from Duke University and Duke Clinical Research Institute, examined data from the HF-ACTION trial. Patients receiving angiotensin-converting enzyme (ACE)-inhibitors and/or angiotensin receptor blockers and beta-adrenergic blockade for six or more weeks were eligible. The HF-ACTION trial included 2,331 patients and only 128 (5.5 percent) were not on beta-blockers. The currently analysis included 2,320 patients. The primary endpoint was all-cause mortality or all-cause hospitalization.

Researchers found a significant inverse relationship between either higher beta-blocker dose or lower heart rate and all-cause death or hospitalization. However, after adjusting for variables found to be significantly associated with the primary endpoint, only higher beta-blocker dose remained significantly associated with improved outcomes regardless of high or low heart rate. There did not appear to be a difference in N-terminal of the prohormone brain natriuretic peptide changes between the two groups, although the researchers did observe a greater absolute change in the higher dose groups. 

The researchers conclude that these findings suggest that titrating beta-blockers may offer a greater benefit to heart failure patients than reducing heart rate.

“There has been increasing interest in the importance of heart rate lowering in heart failure patients,” said Christopher M. O’Connor, MD, FACC, editor-in-chief of JACC: Heart Failure and a co-author of the study. “However, data has shown that beta-blockers are often not titrated to target doses, and that doing so may improve outcomes. Our study supports the concept that titrating to target beta-blocker dose should be first line in improving outcomes.”

Clinical Topics: Heart Failure and Cardiomyopathies, Acute Heart Failure

Keywords: Heart Failure, Adrenergic beta-Agonists, Hospitalization

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