Paul S. Mueller, MD, MPH, FACP reviewing Kotecha D et al. BMJ 2016 Apr 20. Hoes AW. BMJ 2016 Apr 20.

In patients with heart failure (HF) and reduced left ventricular ejection fraction (LVEF), β­blockers lower morbidity and mortality, but whether these benefits are affected by age or sex is uncertain. To explore this issue, industry-­supported researchers conducted a meta-analysis of individual patient data from 11 randomized placebo-controlled trials in nearly 14,000 patients (age range, 40–80; 24% women) who had HF with LVEF <45% and were in sinus rhythm at baseline. Median follow-up was 1.3 years.

Compared with placebo, β­blockers significantly lowered relative risk for all-cause death across all age subgroups, by about 25% to 35%. Absolute reduction in mortality was 4.3% (number needed to treat, 23). No significant interactions were noted between treatment effect and sex in any age group. Similar findings were shown for hospital admissions for HF. Tolerability, as assessed by drug discontinuation rates, was similar to that of placebo (14% and 16%, respectively).

Comment

In this meta-analysis of nearly all available data from β-blocker trials in HF patients with reduced LVEF, β­blockers lowered HF-related mortality and hospitalizations, with tolerability similar to that of placebo, regardless of patients’ age or sex. Clinicians should offer β-blockers to all patients with HF in sinus rhythm with reduced LVEF.

CITATION(S):

Kotecha D et al. Effect of age and sex on efficacy and tolerability of β blockers in patients with heart failure with reduced ejection fraction: Individual patient data meta­analysis. BMJ 2016 Apr 20; 353:i1855. (http://dx.doi.org/10.1136/bmj.i1855) Abstract/FREE Full Text

Hoes AW.β blockers for heart failure. BMJ 2016 Apr 20; 353:i2074. (http://dx.doi.org/10.1136/bmj.i2074)  FREE Full Text