Beta-blockers up risk of adverse cardiovascular outcomes in HFpEF patients
The use of beta-blockers in patients with heart failure with preserved ejection fraction (HFpEF), especially in those without histories of myocardial infarction, appears to increase the risk of adverse cardiovascular events, according to a recent study.
A total of 3,417 HFpEF patients were recruited for the study, of whom 887 had previous myocardial infarction while 2,530 did not. Over a mean follow-up period of 3.3±1.7 years, 778 patients developed the primary outcome of a composite of cardiovascular death, heart failure hospitalization, nonfatal myocardial infarction or stroke, and aborted cardiac arrest.
In all patients, the risk of the primary outcome was significantly higher in those who had vs had not received beta-blockers (adjusted hazard ratio [HR], 1.26; 95 percent CI, 1.04–1.53; p=0.02). The event rate for the primary outcome was likewise higher in those who were given beta-blockers than in those who were not (78.5 vs 58.1 events per 1,000 person-years).
Notably, the effect of beta-blockers was significant only in patients without previous histories of myocardial infraction (adjusted HR, 1.39; 1.11–1.75; p=0.005) and not in those without prior episodes (adjusted HR, 1.08; 0.75–1.57; p=0.67).
The use of beta-blockers and myocardial infarction history showed a significant interaction in the multivariable model (p<0.001 for interaction).
For the present study, patients at least 50 years of age were considered eligible if they had a history of hospitalization for heart failure within the last 12 months. Those with severe pulmonary disease or systemic illnesses were excluded. Cox proportional hazards analyses were performed to quantify the risks according to beta-blocker use.