Beta-Blockers Cut Mortality for Patients in Sinus Rhythm
TUESDAY, June 13, 2017 -- For patients with heart failure with reduced ejection fraction in sinus rhythm, beta-blockers reduce mortality regardless of pre-treatment heart rate, according to a study published in the June 20 issue of the Journal of the American College of Cardiology.
Dipak Kotecha, M.B.B.S., Ph.D., from the University of Birmingham Institute of Cardiovascular Sciences in the United Kingdom, and colleagues conducted a meta-analysis of harmonized individual patient data from 11 double-blind randomized controlled trials involving patients with heart failure with reduced ejection fraction.
The researchers found that for patients in sinus rhythm, a higher heart rate at baseline correlated with greater all-cause mortality (adjusted hazard ratio [HR], 1.11 per 10 beats/minute; 95 percent confidence interval [CI], 1.07 to 1.15; P < 0.0001); this was not seen for patients with atrial fibrillation (AF) (HR, 1.03 per 10 beats/minute; 95 percent CI, 0.97 to 1.08; P = 0.38). In both sinus rhythm and AF, beta-blockers reduced ventricular rate by 12 beats/minute. For patients in sinus rhythm randomized to beta-blockers, mortality was lower (HR, 0.73 versus placebo; 95 percent CI, 0.67 to 0.79; P < 0.001) regardless of heart rate (interaction P = 0.35). For patients with AF, beta-blockers had no impact on mortality (HR, 0.96; 95 percent CI, 0.81 to 1.12; P = 0.58) at any heart rate (interaction P = 0.48).
"Achieving a lower heart rate is associated with better prognosis, but only for those in sinus rhythm," the authors write.
Several authors disclosed financial ties to pharmaceutical companies, including Menarini Farmaceutica Internazionale and GlaxoSmithKline.
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Posted: June 2017