Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Division of Cardiovascular Disease, Lewis Katz Temple School of Medicine, Philadelphia, PA, USA.
Clin Res Cardiol. 2024 Jun;113(6):951-958. doi: 10.1007/s00392-024-02451-0. Epub 2024 May 2.
The evidence regarding beta blocker (BB) benefit in heart failure with preserved ejection fraction (HFpEF) remains inconclusive, leading to consideration of BB withdrawal in this population.
In this study, we retrospectively analyzed the association of BB on all-cause mortality in HFpEF patients.
This is a single-center retrospective cohort study of 20,206 patients with left ventricular ejection fraction (EF) ≥ 50% who were hospitalized with decompensated HF between January 2011 and March 2020. Survival is reported at 30 days, 1 year, and 3 years. A secondary analysis comparing mortality for patients on BB with additional indications including hypertension (HTN), coronary artery disease (CAD), and atrial fibrillation (AF) was completed. Mortality was compared between patients on BB and additional therapies of spironolactone or angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEi/ARBs).
BB showed lower all-cause mortality at 30 days, 1 year, and 3 years (p < 0.0001). This association with lower all-cause mortality was validated by a supplementary propensity score-matched analysis. At 3 years, there was significant mortality reduction with addition of BB to either spironolactone (p = 0.0359) or ACEi/ARBs (p < 0.0001).
In a large single-center retrospective registry, BB use was associated with lower mortality in HFpEF patients with a recent decompensated HF hospitalization. The mortality benefit persisted in those treated with spironolactone or ACEi/ARBs, and in those with AF. This provocative data further highlights the uncertainty of the benefit of BB use in this cohort and calls for re-consideration of BB withdrawal, especially in those tolerating it well, without conclusive, large, and randomized trials showing lack of benefit or harm.
关于心力衰竭射血分数保留（HFpEF）患者中β受体阻滞剂（BB）获益的证据仍不确定，导致考虑在该人群中停用 BB。
本研究回顾性分析了 BB 对 HFpEF 患者全因死亡率的影响。
这是一项单中心回顾性队列研究，纳入了 20206 名左心室射血分数（EF）≥50%的患者，这些患者在 2011 年 1 月至 2020 年 3 月期间因失代偿性 HF 住院。报告 30 天、1 年和 3 年的生存率。完成了一项比较 BB 加用高血压（HTN）、冠状动脉疾病（CAD）和心房颤动（AF）等其他适应证患者死亡率的次要分析。比较了 BB 组与螺内酯或血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂（ACEi/ARBs）等其他治疗方案组患者的死亡率。
BB 在 30 天、1 年和 3 年时的全因死亡率均较低（p<0.0001）。补充倾向评分匹配分析验证了这一与全因死亡率降低的关联。在 3 年时，BB 加用螺内酯（p=0.0359）或 ACEi/ARBs（p<0.0001）可显著降低死亡率。
在一项大型单中心回顾性队列研究中，HFpEF 患者近期因失代偿性 HF 住院时，使用 BB 与死亡率降低相关。在接受螺内酯或 ACEi/ARBs 治疗的患者以及患有 AF 的患者中，这种获益仍然存在。这些有启发性的数据进一步强调了在该队列中使用 BB 的获益不确定，并且需要重新考虑 BB 的停药，特别是对于那些能够耐受 BB 且没有结论性、大型、随机试验表明无获益或有害的患者。
