Beta-blockers could raise risk of hospitalization for those with ‘stiff heart’ HF

Beta-blocker use was linked to an increased risk of heart failure hospitalizations in a recent study of patients with “stiff heart” HF—a concerning finding considering the majority of such patients take the drugs as part of their care regimen.

“Stiff heart” heart failure—also known as heart failure with preserved ejection fraction, or HFpEF—is characterized by an ejection fraction of 50% or greater, Timothy Plante, MD, and colleagues explained in JAMA Network Open Dec. 4. Right now, we know less about HFpEF than we do about heart failure with reduced ejection fraction (HFrEF), or “weak heart” HF, so many physicians lean on established HFrEF therapies as solutions for HFpEF patients.

“A big problem with ‘stiff heart’ heart failure is that we don’t have effective medical therapies,” Plante, an assistant professor of medicine at the Larner College of Medicine at the University of Vermont, said in a release. “So, instead, we use the same medications that work for ‘weak heart’ heart failure. Because beta-blockers save lives in ‘weak heart’ heart failure, we assume they are also effective in ‘stiff heart’ heart failure patients...This assumption may be wrong.”

Plante and his team studied data from 1,761 patients enrolled in the TOPCAT (Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist) trial, a study of the medication spironolactone in individuals with HFpEF. Around four in five (79.2%) TOPCAT participants were on beta-blockers.

Over a follow-up period of about three years, 339 patients (22.7% of the total pool) were hospitalized for HF and 229 (13.0%) died from cardiovascular disease. The authors said beta-blocker use was associated with a 74% higher risk of HF hospitalizations among subjects with HF and a normal pump function, but the drugs weren’t connected to CVD mortality.

Senior author Markus Meyer, MD, an associate professor of medicine at the University of Minnesota Medical School, said in the release that while his team’s study suggests beta-blockers might be a red flag for patients with HFpEF, their work isn’t conclusive. 

“Even people without heart failure will have more shortness of breath and less exercise capacity,” he said. “This has been a known class side effect for decades. It is important to understand that our findings are not proof that beta-blockers are harmful among patients with ‘stiff heart’ heart failure—it is just a concerning signal.”

The authors said next steps include reproducing their findings in other studies and exploring whether there’s a clinical benefit to stopping beta-blockers in patients with HFpEF.