Beta Blockers are Associated with Lower All-Cause Mortality Among Heart Failure Patients with Preserved Ejection Fraction

Experts from the UPMC Heart and Vascular Institute recently published new research on beta blocker benefit in heart failure patients with preserved ejection fraction (HFpEF) in the Clinical Research in Cardiology journal.

This study retrospectively analyzed the association between beta blockers and all-cause mortality in HFpEF patients. The study evaluated 20,206 patients with left ventricular ejection fraction (LVEF) greater than or equal to 50% who were hospitalized with decompensated heart failure. 12,514 patients were on beta blockers, and 7,692 patients were not on beta blockers. Survival was reported at 30 days, 1 year, and 3 years. Researchers also conducted a secondary analysis comparing mortality in patients on beta blockers who had additional conditions such as hypertension, coronary artery disease (CAD), and atrial fibrillation (AF).

The primary outcome of the study was all-cause mortality at 1 year. Secondary outcomes included all-cause mortality of HFpEF patients on beta blockers and additional therapies of spironolactone or angiotensin-converting enzyme inhibitors/angiotension receptor blockers (ACEi/ARBS) at 3 years.

Conclusion of Findings

The study found that use of beta blockers was associated with significantly lower mortality for HFpEF patients with a recent hospitalization for decompensated heart failure. The survival benefit was seen at 30 days, 1 year, and 3 years. The addition of beta blockers to spironolactone or ACEi/ARBS demonstrated significant mortality benefit for patients with LVEF greater than or equal to 50% at 3 years when compared with use of ACEi/ARBS only.

The secondary analysis revealed lower mortality in patients with AF on beta blockers when compared to patients with AF not on beta blockers. The persistence of mortality reduction in patients with AF emphasizes the benefit of beta blocker use in this HFpEF subgroup. There was no significant difference in mortality for patients with CAD or hypertension between the beta blockers cohort and no beta blockers cohort.

The study results highlight the association between beta blocker use and lower all-cause mortality in HFpEF patients. The mortality benefit persisted in patients treated with spironolactone or ACEI/ARBs and in those with AF. Despite prior randomized controlled clinical trials not showing mortality benefit of BB in HFpEF, this large real-world retrospective analysis supports use of beta blocker in HFpEF (especially in the setting of co-morbid conditions such as atrial fibrillation) and calls for further investigations and reconsideration of beta blocker withdrawal in this population.

Reference

Joseph Ibrahim, Carly Fabrizio, Ahmet Sezer, Floyd Thoma, Brenden Boyle, Suresh R. Mulukutla, Jessica H. Huston, Marc A. Simon, Gavin W. Hickey. Beta blockers are associated with lower all-cause mortality among HFpEF patients. Clinical Research in Cardiology (2024). https://doi.org/10.1007/s00392-024-02451-0