Beta-Blockers and Outcome in Heart Failure and Atrial Fibrillation: A Meta-Analysis

Study Questions:

Do beta-blockers improve outcomes in patients with heart failure (HF) who have atrial fibrillation (AF)?


This was a meta-analysis of four randomized clinical trials of a beta-blocker versus placebo in patients with HF and an ejection fraction <40%. The primary outcomes were all-cause mortality and HF hospitalizations. These outcomes were analyzed separately for patients with and without AF.


There were a total of 1,667 patients (mean age 68 years) with AF: 842 in the beta-blocker group and 835 in the placebo group. A total of 7,003 patients (mean age 63 years) were in sinus rhythm: 3,640 in the beta-blocker group and 3,363 in the placebo group. There was not a significant difference in mortality between the beta-blocker group and the placebo group in patients with AF. In the patients without AF, the mortality rate was 37% lower in the beta-blocker group than in the placebo group. The rate of HF hospitalizations was not significantly different between the two study arms in patients with AF, and was 42% lower in the beta-blocker group among the patients without AF.


Beta-blockers do not improve major outcomes in patients with HF who have AF.


The reasons for the different effect of beta-blockers on outcomes between patients with and without AF are unclear. Two possibilities are that the rate-modulation effects of beta-blockers are exerted on the atrioventricular node instead of the sinus node in the setting of AF, or that the beneficial effects of beta-blockers are counterbalanced by negative effects of AF on survival.

Clinical Topics: Heart Failure and Cardiomyopathies, Acute Heart Failure

Keywords: Heart Failure

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