January 18, 2017
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Beta-blockers may lower mortality, but not hospitalization in patients with HF, AF

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In patients with HF and atrial fibrillation, beta-blockers are associated with significantly lower mortality but not hospitalization, regardless of the pattern or burden of atrial fibrillation, new data show.

Julia Ca drin-Tourigny, MD, of the Montreal Heart Institute at Université de Montréal, and colleagues studied patients with both AF and HF with reduced ejection fraction to analyze the effect beta-blockers had on all-cause mortality, CV mortality and hospitalization.

Of the 1,376 participants (mean age, 70 years; 81% men; mean left ventricular EF, 27%), 79% (n = 1,085) received beta-blockers. For those who did not receive beta-blockers, the reasons given were physician preference (42%), pulmonary disease (24%), intolerance (18%) and other (6%). The cohort was propensity-matched.

Through a median follow-up of 37 months, 35% of patients died (n = 231), 42% of those without beta-blockers (n = 95) and 31% of those with beta-blockers (n = 136).

Beta-blockers were associated with a significantly lower risk for mortality (HR = 0.721; 95% CI, 0.549-0.945), according to the researchers. Although not significant, beta-blockers were associated with fewer hospitalizations (HR = 0.886; 95% CI, 0.715-1.1).

When the researchers modeled beta-blockers as a time-dependent variable, similar results occurred (all-cause mortality HR = 0.668, 95% CI, 0.511-0.874; hospitalizations HR = 0.814; 95% CI, 0.653-1.014).

Additionally, no significant interactions were found between beta-blockers and burden or pattern of AF.

The limitations of the study included its retrospective nature, not recording the agent and dose of beta-blockers, and the study population being limited to patients with HFrEF and nonpermanent AF at baseline, Cadrin-Tourigny and colleagues wrote.

“Notwithstanding the acknowledged limitations and the smaller sample size, our results challenge a contemporary patient-level meta-analysis and lend credence to current guidelines, which recommend beta-blockers for patients with [HFrEF], without distinguishing between those with or without AF,” the researchers wrote. – by Cassie Homer

Disclosures: The researchers report no relevant financial disclosures.