Matsumoto Shingo, Henderson Alasdair D, Shen Li, Kondo Toru, Yang Mingming, Campbell Ross T, Anand Inder S, de Boer Rudolf A, Desai Akshay S, Lam Carolyn S P, Maggioni Aldo P, Martinez Felipe A, Packer Milton, Redfield Margaret M, Rouleau Jean L, Van Veldhuisen Dirk J, Vaduganathan Muthiah, Zannad Faiez, Zile Michael R, Jhund Pardeep S, Solomon Scott D, McMurray John J V
British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK.
Division of Cardiovascular Medicine, Department of Internal Medicine, Faculty of Medicine, Toho University, Tokyo, Japan.
Eur J Heart Fail. 2025 Jan;27(1):124-139. doi: 10.1002/ejhf.3383. Epub 2024 Aug 31.
In the absence of randomized trial evidence, we performed a large observational analysis of the association between beta-blocker (BB) use and clinical outcomes in patients with heart failure (HF) and mildly reduced (HFmrEF) and preserved ejection fraction (HFpEF).
We pooled individual patient data from four large HFmrEF/HFpEF trials (I-Preserve, TOPCAT, PARAGON-HF, and DELIVER). The primary outcome was the composite of cardiovascular death or HF hospitalization. Among the 16 951 patients included, the mean left ventricular ejection fraction (LVEF) was 56.8%, and 13 400 (79.1%) had HFpEF (LVEF ≥50%). Overall, 12 812 patients (75.6%) received a BB. The median bisoprolol-equivalent dose of BB was 5.0 (Q1-Q3: 2.5-5.0) mg with BB continuation rates of 93.1% at 2 years (in survivors). The unadjusted hazard ratio (HR) for the primary outcome did not differ between BB users and non-users (HR 0.98, 95% confidence interval [CI] 0.91-1.05), but the adjusted HR was lower in BB users than non-users (0.81, 95% CI 0.74-0.88), and this association was maintained across LVEF (p = 0.88). In subgroup analyses, the adjusted risk of the primary outcome was similar in BB users and non-users with or without a history of myocardial infarction, hypertension, or a baseline heart rate <70 bpm. By contrast, a better outcome with BB use was seen in patients with atrial fibrillation compared to those without atrial fibrillation (p = 0.02).
In this observational analysis of non-randomized BB treatment, there was no suggestion that BB use was associated with worse HF outcomes in HFmrEF/HFpEF, even after extensive adjustment for other prognostic variables.
在缺乏随机试验证据的情况下，我们对β受体阻滞剂（BB）的使用与心力衰竭（HF）、射血分数轻度降低（HFmrEF）和射血分数保留（HFpEF）患者临床结局之间的关联进行了大规模观察性分析。
我们汇总了四项大型HFmrEF/HFpEF试验（I-Preserve、TOPCAT、PARAGON-HF和DELIVER）的个体患者数据。主要结局是心血管死亡或HF住院的复合结局。在纳入的16951例患者中，平均左心室射血分数（LVEF）为56.8%，13400例（79.1%）患有HFpEF（LVEF≥50%）。总体而言，12812例患者（75.6%）接受了BB治疗。BB的中位比索洛尔等效剂量为5.0（四分位间距：2.5 - 5.0）mg，2年时BB持续使用率为93.1%（在存活者中）。主要结局的未调整风险比（HR）在BB使用者和非使用者之间无差异（HR 0.98，95%置信区间[CI] 0.91 - 1.05），但调整后的HR在BB使用者中低于非使用者（0.81，95% CI 0.74 - 0.88），并且这种关联在整个LVEF范围内均保持（p = 0.88）。在亚组分析中，有或无心肌梗死、高血压病史或基线心率<70次/分的BB使用者和非使用者中，主要结局的调整后风险相似。相比之下，与无房颤患者相比，房颤患者使用BB的结局更好（p = 0.02）。
在这项非随机BB治疗的观察性分析中，即使在对其他预后变量进行广泛调整后，也没有迹象表明在HFmrEF/HFpEF中使用BB与更差的HF结局相关。
