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'No difference' between beta-blockers for heart failure

There is no significant difference between classes of beta-blockers in reducing mortality from heart failure, say researchers.

The study

The meta-analysis looked at 21 randomised trials that compared beta-blockers in patients diagnosed with heart failure with reduced ejection fraction, and looked at their influence on mortality. A total of 23,122 patients were included in the analysis across the 21 trials analysed.

The findings

Of all the beta-blockers analysed, atenolol and carvedilol had the greatest effect on reducing mortality, when compared with placebo or standard treatment, reducing the risk of death by 47% and 44% respectively. Bisoprolol was the next best, reducing risk by 35% compared to placebo or standard treatment. However, when these three were compared to other beta-blockers for the same outcome, there were no significant differences between them.

What it means for GPs?

The authors concluded that, given the lack of differences in improvement of mortality with individual beta-blockers, they considered it ‘pragmatic’ to infer that three agents – bisoprolol, sustained release metoprolol succinate, and carvedilol - should be used They said these drugs had been tested more extensively and had been shown to be superior to placebo.

Expert comment

Dr Ahmet Fuat, cardiology GPSI in Darlington: ‘The study concurs with current GP practice. The three beta blockers they recommend are the most commonly used, though I would also suggest nebivolol for older patients with erectile dysfunction.’

BMJ 2013, available online 16 January

Readers' comments (2)

  • Interesting. So back to Atenolol.
    Whilst mortality is an important "end-point", and since there are no significant differences between beta-blockers in that respect, what about quality of life comparing the beta-blockers.

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  • mmm...beware thinking atenolol is therefore ok. Need to see the detail. The summary suggests bisoprolol, metoprolol and carvedilol (longstanding advice) and I agree with Ahmet on the addition of nebivolol for elderly. Atenolol has been shown in some studies to be significantly inferior...so lets await the detailed debate before changing the accepted practice. Where is Philip Poole Wilson when we need him (RIP)...his talks around this were some of the most informative and helpful I have come across in my heart failure work.

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