Lillehei Heart Institute, Department of Cardiology, University of Minnesota, Minneapolis, USA.
Cardiovascular Research Institute Basel (CRIB) and Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland.
J Card Fail. 2021 Nov;27(11):1165-1174. doi: 10.1016/j.cardfail.2021.04.015. Epub 2021 May 8.
β-Blockers have an uncertain effect in heart failure with a preserved ejection fraction of 50% or higher (heart failure with preserved ejection fraction [HFpEF]).
We included patients with HFpEF from the Swedish Heart Failure Registry (SwedeHF) enrolled from 2011 through 2018. In a 2:1 propensity-score matched analysis (β-blocker use vs nonuse), we assessed the primary outcome first HF hospitalization, the coprimary outcome cardiovascular (CV) death, and the secondary outcomes of all-cause hospitalization and all-cause death. We performed intention-to-treat and a per-protocol consistency analyses. There were a total of 14,434 patients (median age 79 years, IQR 71-85 years, 51% women); 80% were treated with a β-blocker at baseline. Treated patients were younger and had higher rates of atrial fibrillation and coronary artery disease, and higher N-terminal pro-B-type natriuretic peptide levels. In the 4412:2206 patient matched cohort, at 5 years, 42% (95% CI 40%-44%) vs 44% (95% CI 41%-47%) had a HF admission and 38% (IQR 36%-40%) vs 40% (IQR 36%-42%) died from CV causes. In the intention-to-treat analysis, β-blocker use was not associated with HF admissions (hazard ratio 0.95 [95% CI 0.87-1.05, P = .31]) or CV death (hazard ratio 0.94 [95% CI 0.85-1.03, P = .19]). In the subgroup analyses, men seemed to have a more favorable association between β-blockers and outcomes than did women. There were no associations between β-blocker use and secondary outcomes.
In patients with HFpEF, β-blocker use is common but not associated with changes in HF hospitalization or cardiovascular mortality. In the absence of a strong rational and randomized control trials the case for β-blockers in HFpEF remains inconclusive.
● The effect of β-blockers with heart failure with preserved ejection fraction of 50% or greater is uncertain.● In a propensity score-matched heart failure with preserved ejection fraction analysis in the SwedeHF registry, β-blockers were not associated with a change in risk for heart failure admissions or cardiovascular deaths.
The optimal treatment for heart failure with a preserved pump function remains unknown. Despite the lack of scientific studies, β-blockers are very commonly used. When matching patients with a similar risk profile in a large heart failure registry, the use of β-blockers for the treatment of heart failure with a preserved pump function was not associated with any changes in heart failure hospital admissions or cardiovascular death.
β受体阻滞剂在射血分数保留的心力衰竭（HFpEF）达到 50%或更高水平时效果不确定（HFpEF）。
我们纳入了 2011 年至 2018 年期间瑞典心力衰竭注册中心（SwedeHF）纳入的 HFpEF 患者。在 2:1 倾向评分匹配分析（β受体阻滞剂使用与非使用）中，我们评估了主要结局首次心力衰竭住院，共同主要结局心血管（CV）死亡以及全因住院和全因死亡的次要结局。我们进行了意向治疗和方案一致性分析。共有 14434 名患者（中位年龄 79 岁，IQR 71-85 岁，51%为女性）；基线时 80%接受了β受体阻滞剂治疗。治疗组患者更年轻，心房颤动和冠状动脉疾病的发生率更高，N 末端脑钠肽前体水平也更高。在 4412：2206 名患者匹配队列中，5 年后，42%（95%CI 40%-44%）与 44%（95%CI 41%-47%）发生心力衰竭入院，38%（IQR 36%-40%）与 40%（IQR 36%-42%）因心血管原因死亡。在意向治疗分析中，β受体阻滞剂的使用与心力衰竭入院（危险比 0.95[95%CI 0.87-1.05，P=0.31]）或心血管死亡（危险比 0.94[95%CI 0.85-1.03，P=0.19]）无关。在亚组分析中，男性似乎比女性与β受体阻滞剂之间的相关性更有利。β受体阻滞剂的使用与次要结局之间没有关联。
在 HFpEF 患者中，β受体阻滞剂的使用很常见，但与心力衰竭住院或心血管死亡率的变化无关。在缺乏强有力的合理和随机对照试验的情况下，HFpEF 中β受体阻滞剂的情况仍不确定。
射血分数保留的心力衰竭 50%或更高的β受体阻滞剂的效果尚不确定。
在 SwedeHF 注册中心进行的射血分数保留的心力衰竭倾向性评分匹配分析中，β受体阻滞剂的使用与心力衰竭入院或心血管死亡风险的变化无关。
保留泵功能的心力衰竭的最佳治疗方法仍不清楚。尽管缺乏科学研究，但β受体阻滞剂的使用非常普遍。在大型心力衰竭注册中心中对具有相似风险特征的患者进行匹配时，使用β受体阻滞剂治疗保留泵功能的心力衰竭与心力衰竭住院或心血管死亡的任何变化均无关。
