Liu Feng, Chen Yanmei, Feng Xuguang, Teng Zhonghua, Yuan Ye, Bin Jianping
Department of Cardiology and National Key Lab for Organ Failure Research, Nanfang Hospital, Southern Medical University, Guangzhou, China.
PLoS One. 2014 Mar 5;9(3):e90555. doi: 10.1371/journal.pone.0090555. eCollection 2014.
Effects of beta-blockers on the prognosis of the heart failure patients with preserved ejection fraction (HFpEF) remain controversial. The aim of this meta-analysis was to determine the impact of beta-blockers on mortality and hospitalization in the patients with HFpEF.
A search of MEDLINE, EMBASE, and the Cochrane Library databases from 2005 to June 2013 was conducted. Clinical studies reporting outcomes of mortality and/or hospitalization for patients with HFpEF (EF ≥ 40%), being assigned to beta-blockers treatment and non-beta-blockers control group were included.
A total of 12 clinical studies (2 randomized controlled trials and 10 observational studies) involving 21,206 HFpEF patients were included for this meta-analysis. The pooled analysis demonstrated that beta-blocker exposure was associated with a 9% reduction in relative risk for all-cause mortality in patients with HFpEF (95% CI: 0.87 - 0.95; P < 0.001). Whereas, the all-cause hospitalization, HF hospitalization and composite outcomes (mortality and hospitalization) were not affected by this treatment (P=0.26, P=0.97, and P=0.88 respectively).
The beta-blockers treatment for the patients with HFpEF was associated with a lower risk of all-cause mortality, but not with a lower risk of hospitalization. These finding were mainly obtained from observational studies, and further investigations are needed to make an assertion.
β受体阻滞剂对射血分数保留的心力衰竭（HFpEF）患者预后的影响仍存在争议。本荟萃分析的目的是确定β受体阻滞剂对HFpEF患者死亡率和住院率的影响。
检索了2005年至2013年6月的MEDLINE、EMBASE和Cochrane图书馆数据库。纳入报告了HFpEF（射血分数≥40%）患者死亡率和/或住院结局的临床研究，这些患者被分配到β受体阻滞剂治疗组和非β受体阻滞剂对照组。
本荟萃分析共纳入12项临床研究（2项随机对照试验和10项观察性研究），涉及21206例HFpEF患者。汇总分析表明，HFpEF患者使用β受体阻滞剂与全因死亡率相对风险降低9%相关（95%置信区间：0.87 - 0.95；P < 0.001）。然而，这种治疗对全因住院、心力衰竭住院和综合结局（死亡率和住院率）没有影响（P分别为0.26、0.97和0.88）。
HFpEF患者使用β受体阻滞剂治疗与全因死亡率风险降低相关，但与住院风险降低无关。这些发现主要来自观察性研究，需要进一步研究以得出结论。
