Perspective:

There is paucity of data to inform the efficacy of β-blockers in patients with heart failure and concomitant atrial fibrillation, even though they often co-exist. Notwithstanding the limitations associated with meta-analytic techniques, this is an important study that draws question to the preferential use of beta-blockers compared with other rate-control agents in patients with heart failure and atrial fibrillation. That said and although the authors found no evidence that β-blocker therapy prevents major adverse cardiovascular events in patients with both heart failure and atrial fibrillation, the current analysis did establish safety of this strategy in this population (i.e., no increase in mortality or hospital admission rates). As the negative inotropic effect of the non-dihydropyridine calcium channel antagonists may be deleterious in patients with heart failure and given the limitations of digoxin monotherapy (for the purposes of rate control), perhaps β-blocker therapy remains the best option for rate control in those with heart failure and concomitant atrial fibrillation.