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Mortality benefits of beta-blockers reduced in patients with AF

Patients with heart failure gain less benefit from beta-blockers if they also have atrial fibrillation, say researchers.

The study

Researchers in the UK and Netherlands conducted a meta-analysis featuring four trials that investigated beta-blocker therapy in patients with heart failure and atrial fibrillation, and in patients with heart failure with reduced systolic left ventricular ejection fraction of below 35%. The included trials featured a total of 8,680 patients.

The findings

Patients with heart failure and atrial fibrillation had a 14% decreased risk of mortality, compared with patients on placebo. Patients with heart failure in sinus rhythm had a 37% decreased risk of mortality, compared with placebo. The difference between the two risks was significant. Beta-blocker therapy in patients did not reduce the risk of hospitalisation from heart failure compared to placebo patients. However, it did significantly reduce the risk of hospitalisation from heart failure by 42% in patients in sinus rhythm, compared with placebo.

What does it mean for GPs?

The authors concluded that the effect of beta-blockers is ‘significantly different’ in patients with heart failure and atrial fibrillation compared with patients in sinus rhythm. They did, however, note that ‘carvedilol had a relatively favourable effect in the analysis in atrial fibrillation patients’ in the one study that examined it, but that those patients had milder disease than other studies.

JACC Heart Failure 2013, online February 2013

 

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