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Beta-blockers and 1-year clinical outcomes in hospitalized heart failure patients with atrial fibrillation. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2021; 18:728-738. [PMID: 34659379 PMCID: PMC8501385 DOI: 10.11909/j.issn.1671-5411.2021.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To assess the association between beta-blockers and 1-year clinical outcomes in heart failure (HF) patients with atrial fibrillation (AF), and further explore this association that differs by left ventricular ejection fraction (LVEF) level. METHODS We enrolled hospitalized HF patients with AF from China Patient-centered Evaluative Assessment of Cardiac Events Prospective Heart Failure Study. COX proportional hazard regression models were employed to calculate hazard ratio of beta-blockers. The primary outcome was all-cause death. RESULTS Among 1762 HF patients with AF (756 women [41.4%]), 1041 (56%) received beta-blockers at discharge and 1272 (72.2%) had an LVEF > 40%. During one year follow up, all-cause death occurred in 305 (17.3%), cardiovascular death occurred in 203 patients (11.5%), and rehospitalizations for HF occurred in 622 patients (35.2%). After adjusting for demographic characteristics, social economic status, smoking status, medical history, anthropometric characteristics, and medications used at discharge, the use of beta-blockers at discharge was not associated with all-cause death [hazard ratio (HR): 0.86; 95% Confidence Interval (CI): 0.65−1.12; P = 0.256], cardiovascular death (HR: 0.76, 95% CI: 0.52−1.11; P = 0.160), or the composite outcome of all-cause death and HF rehospitalization (HR: 0.97, 95% CI: 0.82−1.14; P = 0.687) in the entire cohort. There were no significant interactions between use of beta-blockers at discharge and LVEF with respect to all-cause death, cardiovascular death, or composite outcome. In the adjusted models, the use of beta-blockers at discharge was not associated with all-cause death, cardiovascular death, or composite outcome across the different levels of LVEF: reduced (< 40%), mid-range (40%−49%), or preserved LVEF (≥ 50%).
CONCLUSION Among HF patients with AF, the use of beta-blockers at discharge was not associated with 1-year clinical outcomes, regardless of LVEF.
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Hudoyo AW, Fukuda H, Imazu M, Shindo K, Fu H, Iwata Y, Ito S, Kitakaze M. Heart rate determines the beneficial effects of beta-blockers on cardiovascular outcomes in patients with heart failure and atrial fibrillation. Hypertens Res 2019; 42:1716-1725. [DOI: 10.1038/s41440-019-0289-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 04/25/2019] [Accepted: 05/18/2019] [Indexed: 11/09/2022]
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da Silva RMFL, Borges ASR, Silva NP, Resende ES, Tse G, Liu T, Roever L, Biondi-Zoccai G. How Heart Rate Should Be Controlled in Patients with Atherosclerosis and Heart Failure. Curr Atheroscler Rep 2018; 20:54. [PMID: 30225613 DOI: 10.1007/s11883-018-0757-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Resting heart rate is an independent risk factor for all-cause and cardiovascular mortality in patients with heart failure. The main objectives are to discuss the prognosis of heart rate, its association with coronary atherosclerosis, and the modalities of control of the heart rate in sinus rhythm and in the rhythm of atrial fibrillation in patients with chronic heart failure. RECENT FINDINGS As a therapeutic option for control heart rate, medications such as beta-blockers, digoxin, and finally ivabradine have been studied. Non-dihydropyridine calcium channel blockers are contraindicated in patients with heart failure and reduced ejection fraction. The influence of the magnitude of heart rate reduction and beta-blocker dose on morbidity and mortality will be discussed. Regarding the patients with heart failure and atrial fibrillation, there are different findings in heart rate control with the use of a beta-blocker. Patients eligible for ivabradine have clinical benefits and increased ejection fraction. Vagal nerve stimulation has low efficacy for the control of heart rate. Complementary therapies such as tai chi and yoga showed no effect on heart rate. In this review, we discuss the main therapeutic options for the control of heart rate in patients with atherosclerosis and heart failure. More research is needed to examine the effects of therapeutic options for heart rate control in different population types, as well as their effects on clinical outcomes and impact on morbidity and mortality.
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Affiliation(s)
| | | | - Nilson Penha Silva
- Department of Clinical Research, Federal University of Uberlandia, Uberlândia, Brazil
| | - Elmiro Santos Resende
- Department of Clinical Research, Federal University of Uberlandia, Uberlândia, Brazil
| | - Gary Tse
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
- Faculty of Medicine, Li KaShing Institute of Health Sciences, Chinese University of Hong Kong, Hong Kong, China
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, the Second Hospital of Tianjin Medical University, Tianjin, China
| | - Leonardo Roever
- Department of Clinical Research, Federal University of Uberlandia, Uberlândia, Brazil
| | - Giuseppe Biondi-Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
- Department of AngioCardioNeurology, IRCCS Neuromed, Pozzilli, Italy
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Cadrin-Tourigny J, Shohoudi A, Roy D, Talajic M, Tadros R, Mondésert B, Dyrda K, Rivard L, Andrade JG, Macle L, Guerra PG, Thibault B, Dubuc M, Khairy P. Decreased Mortality With Beta-Blockers in Patients With Heart Failure and Coexisting Atrial Fibrillation: An AF-CHF Substudy. JACC-HEART FAILURE 2017; 5:99-106. [PMID: 28089316 DOI: 10.1016/j.jchf.2016.10.015] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 10/25/2016] [Accepted: 10/25/2016] [Indexed: 12/20/2022]
Abstract
OBJECTIVES The impact of beta-blockers on mortality and hospitalizations was assessed in the largest randomized trial of patients with both atrial fibrillation (AF) and heart failure with a reduced ejection fraction (HFrEF): the Atrial Fibrillation-Congestive Heart Failure trial. BACKGROUND Although beta-blockers are the cornerstone of therapy for HFrEF, a recent patient-level meta-analysis cast doubt on their efficacy in patients with coexisting AF. METHODS From a total of 1,376 subjects randomized in the AF-CHF trial, those without beta-blockers at baseline were propensity matched to a maximum of 2 exposed patients. All absolute standardized differences after matching were ≤10%. Primary analyses respected the intention-to-treat principle. In on-treatment sensitivity analyses, beta-blocker status was modeled as a time-dependent covariate. RESULTS Baseline characteristics were comparable among the matched cohorts (mean age 70 ± 11 years, 81% male, and mean left ventricular ejection fraction 27 ± 6%). During a median follow-up of 37 months, beta-blockers were associated with significantly lower all-cause mortality (hazard ratio [HR]: 0.721, 95% confidence interval [CI]: 0.549 to 0.945; p = 0.0180) but not hospitalizations (HR: 0.886; 95% CI: 0.715 to 1.100; p = 0.2232). Similar results were obtained in sensitivity analyses that modeled beta-blockers as a time-dependent variable (HR: 0.668 for all-cause mortality; 95% CI: 0.511 to 0.874; p = 0.0032; HR: 0.814 for hospitalizations; 95% CI: 0.653 to 1.014; p = 0.0658). There were no significant interactions between beta-blockers and patterns (i.e., persistent vs. paroxysmal) or burden of AF with respect to mortality or hospitalizations. CONCLUSIONS In propensity-matched analyses, beta-blockers were associated with significantly lower mortality but not hospitalizations in patients with HFrEF and AF, irrespective of the pattern or burden of AF. These results support current evidence-based recommendations for beta-blockers in patients with HFrEF, whether or not they have associated AF.
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Affiliation(s)
| | - Azadeh Shohoudi
- Montreal Health Innovations Coordinating Center, Université de Montréal, Montreal, Quebec, Canada
| | - Denis Roy
- Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Mario Talajic
- Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Rafik Tadros
- Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Blandine Mondésert
- Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Katia Dyrda
- Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Léna Rivard
- Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Jason G Andrade
- Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Laurent Macle
- Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Peter G Guerra
- Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Bernard Thibault
- Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Marc Dubuc
- Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Paul Khairy
- Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada; Montreal Health Innovations Coordinating Center, Université de Montréal, Montreal, Quebec, Canada.
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