Beta-blockers appeared to offer no or little clinical benefit to patients with heart failure and atrial fibrillation in a study presented at the European Society of Cardiology’s annual meeting and concurrently published online Sept. 2 in The Lancet.
Lead Author Dipak Kotecha, PhD, of the Center for Cardiovascular Sciences at the University of Birmingham, and colleagues reviewed collected meta-data on 18,254 heart failure patients as part of the Beta-Blockers in Heart Failure Collaborative Group. Sinus rhythm was detected in 76 percent of patients and atrial fibrillation was detected in 17 percent of patients at baseline.
Beta-blockers effectively reduced heart rate, however, as with other recent studies, lowering heart rate did not necessarily equate with improved outcomes. In patients with sinus rhythm at baseline, 16 percent died as opposed to 21 percent of patients with atrial fibrillation. Hazard ratios for patients on beta-blocker therapy showed a better outcome for heart failure patients with sinus rhythm as opposed to atrial fibrillationl.
While they did not find an increased rate of mortality over placebo, beta-blockers did not hold the same mortality-lowering promise seen in patients with heart failure and sinus rhythm. Kotecha et al wrote that beta-blockers, therefore, should not be used as standard treatment for heart failure patients with atrial fibrillation, but could be used safely if atrial fibrillation occurred in conjunction with other symptomologies that would be positively affected by beta-blocker use, such as MI or a need to slow rapid heart rate.
Beta-blockers also appeared to reduce the incidence of atrial fibrillation in patients who presented with sinus rhythm at baseline.
The research team wrote that this data would assist physicians in best care by identifying a subgroup of heart failure patients in whom beta-blockers are not as useful. Further analyses are planned to determine other factors that would affect outcomes with beta-blocker use.
This research was supported by Menarini Farmaceutica Internazionale.