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Beta-Blocker Use and HF Outcomes in Mildly Reduced and Preserved EF
Quick Takes
- This large observational study of patients ≥65 years of age with HF and LVEF ≥40% reports highly significant interactions between beta-blocker use and LVEF for both HF hospitalization and death.
- In patients with HFmrEF, beta-blockers appeared to be protective, but in patients with higher LVEF, particularly >60%, beta-blocker use was associated with no benefit in survival and a higher risk of HF hospitalization.
- These data suggest caution with use of beta-blockers in patients with HFpEF given a potentially higher risk of poor outcomes in these patients.
Study Questions:
What is the association of beta-blockers with heart failure (HF) hospitalization and death in patients with HF and ejection fraction (EF) ≥40%?
Methods:
The investigators assessed beta-blocker use at first encounter in outpatients ≥65 years of age with HF with mildly reduced EF (HFmrEF) and HF with preserved EF (HFpEF) in the Veradigm Cardiology Registry (formerly the PINNACLE Registry). The associations of beta-blockers with HF hospitalization, death, and the composite of HF hospitalization/death were assessed using propensity-score adjusted multivariable Cox regression models, including interactions of EF × beta-blocker use.
Results:
Among 435,897 patients with HF and EF ≥40% (75,674 HFmrEF; 360,223 HFpEF), 289,377 (66.4%) were using a beta-blocker at first encounter; more commonly in patients with HFmrEF versus HFpEF (77.7% vs. 64.0%; p < 0.001). There were significant interactions between EF × beta-blocker use for HF hospitalization, death, and composite of HF hospitalization/death (p < 0.001 for all), with higher risk with beta-blocker use as EF increased. Beta-blockers were associated with decreased risk of HF hospitalization and death in patients with HFmrEF but a lack of survival benefit and a higher risk of HF hospitalization in patients with HFpEF, particularly when EF was >60%.
Conclusions:
The authors report that beta-blocker use was associated with a higher risk of HF hospitalization as EF increased, with potential benefit in patients with HFmrEF and potential risk in patients with higher EF.
Perspective:
This large observational study of patients ≥65 years of age with HF and LVEF ≥40%, reports highly significant interactions between beta-blocker use and LVEF for both HF hospitalization and death, such that the risk associated with beta-blocker use increased as LVEF increased. In patients with HFmrEF, beta-blockers appeared to be protective, but in patients with higher LVEF, particularly >60%, beta-blocker use was associated with no benefit in survival and a higher risk of HF hospitalization. These data suggest caution with use of beta-blockers in patients with HFpEF given a potentially higher risk of poor outcomes in these patients. Additional prospective trials are indicated to better understand the appropriate role and potential risks with beta-blockers in patients with HF and LVEF ≥40%.
Clinical Topics: Geriatric Cardiology, Heart Failure and Cardiomyopathies, Prevention, Acute Heart Failure, Chronic Heart Failure
Keywords: Adrenergic beta-Antagonists, Geriatrics, Heart Failure, Heart Failure, Diastolic, Heart Failure, Systolic, Hospitalization, National Cardiovascular Data Registries, Outpatients, PINNACLE Registry, Risk, Secondary Prevention, Stroke Volume, Survival
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