Beta-Blockers and Mortality Reduction in Heart Failure: A Systematic Review of Randomized Controlled Trials: Impact of Beta-Blockers on Heart Failure

Muhammad Abdullah; Shaheer  Ajmal; Muhammad Jaleed  Khan; Minahil  Khan; Izan  Abbas; Zanali  Razvi

doi:10.69750/dmls.01.08.078

Authors

Muhammad Abdullah Akhtar saeed medical & Dental college lahore, Pakistan Author
Shaheer Ajmal Allama Iqbal Medical College (AIMC), Lahore, Pakistan Author
Muhammad Jaleed Khan Allama Iqbal Medical College (AIMC), Lahore, Pakistan Author
Minahil Khan Allama Iqbal Medical College,Lahore,Pakistan Author
Izan Abbas Akhtar saeed medical & Dental college lahore, Pakistan Author
Zanali Razvi Akhtar Saeed Medical & Dental College, Lahore, Pakistan Author

DOI:

https://doi.org/10.69750/dmls.01.08.078

Keywords:

beta-blockers, heart failure, mortality, hospital admissions, cardiovascular mortality, randomized controlled trials

Abstract

Background: Heart failure is a leading cause of morbidity and mortality. This systematic review evaluates beta blockers' effects on all-cause mortality, cardiovascular mortality, and hospital admissions in heart failure, synthesizing data from over 50 randomized controlled trials.

Methods: Using PRISMA principles, the data regarding the effect of beta blockers on heart failure mortality and hospitalizations were synthesized. Extensive database searches (PubMed, Embase, Cochrane Library, and Web of Science) and manual reference checks were used to identify randomized controlled studies that compared beta blockers with placebo or conventional treatment in adults. The quality of data extraction process was evaluated according to the Cochrane Risk of Bias tool following the guidelines. Heterogeneity was assessed (I2), sensitivity analyses guaranteed robustness, and random-effects meta-analyses quantified results. Transparency was guaranteed via PROSPERO registration.

Results: Beta-blockers were linked to a 29% decrease in cardiovascular mortality (OR 0.71, 95% CI 0.64–0.79, p< 0.05) and a 33% decrease in all cause mortality (OR 0.67, 95% CI 0.59–0.76, p < 0.05) when compared to alternative therapies. Additionally, beta-blocker-treated patients saw a 37% decrease in hospital admissions (OR 0.63, 95% CI: 0.56–0.71, p < 0.05). The class impact of beta blockers in heart failure treatment is supported by these advantages which were constant across subgroups and beta blocker types.

Conclusion: This systematic review corroborates the well-established benefit of beta blockers in lowering mortality and hospitalizations in heart failure patients, particularly with HFrEF. The findings support the use of beta blockers as a cornerstone of heart failure therapy and there is a need for further research to optimize the use of beta blockers in combination with other emerging therapies.

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References

Fukuta H, Goto T, Wakami K, Kamiya T, Ohte N. Effect of beta-blockers on heart failure severity in patients with HFpEF: a meta-analysis of RCTs. Heart Fail Rev. 2021;26(1):165-71. doi:10.1007/s10741-020-10013-5.

Wu M, Ni D, Huang LL, Qiu S. Association between beta-blockers, calcium channel blockers, mortality and hospitalization in HFpEF: a meta-analysis of RCTs. Clin Cardiol. 2023;46(8):845-52. doi:10.1002/clc.24058.

Thomopoulos C, Bazoukis G, Tsioufis C, Mancia G. Beta-blockers in hypertension: overview and meta-analysis of outcome trials. J Hypertens. 2020;38(9):1669-81. doi:10.1097/HJH.0000000000002523.

Li X, Li Y, Zhang T, Xiong X, Liu N, Pang B, et al. Cardioprotective agents for chemotherapy-induced HF: systematic review & network meta-analysis. Pharmacol Res. 2020;151:104577. doi:10.1016/j.phrs.2019.104577.

Yang YL, Xiang ZJ, Yang JH, Wang WJ, Xu ZC, Xiang RL. β-blocker use and survival/pulmonary function in COPD + CVD: systematic review & meta-analysis. Eur Heart J. 2020;41(46):4415-22. doi:10.1093/eurheartj/ehaa793.

Kim Y, Byun S, Kim HY, Kim DB. Long-term beta-blocker therapy after MI without HF in the reperfusion era: systematic review & meta-analysis. J Cardiovasc Pharmacol. 2022;79(5):650-4. doi:10.1097/FJC.0000000000001221.

Maqsood MH, Alam M, Atar D, Birnbaum Y. Long-term beta-blockers after PCI for STEMI with preserved LVEF: systematic review & meta-analysis. J Cardiovasc Pharmacol. 2021;77(1):87-93. doi:10.1097/FJC.0000000000000922.

Tini G, Bertero E, Signori A, Sormani MP, Maack C, de Boer RA, et al. Cancer mortality in HFrEF trials: systematic review & meta-analysis. J Am Heart Assoc. 2020;9(18):e016309. doi:10.1161/JAHA.119.016309.

Attar A, Behnagh AK, Hosseini M, Amanollahi F, Shafiekhani P, Kabir A. Beta-blockers for prevention of anthracycline-induced cardiotoxicity: updated meta-analysis. Cardiovasc Ther. 2022;2022:8367444. doi:10.1155/2022/8367444.

Gama F, Ferreira J, Carmo J, Costa FM, Carvalho S, Carmo P, et al. ICDs in drug therapy trials for HF: systematic review & meta-analysis. J Am Heart Assoc. 2020;9(8):e015177. doi:10.1161/JAHA.119.015177.

Masarone D, Martucci ML, Errigo V, Pacileo G. Use of β-blockers in HFrEF. J Cardiovasc Dev Dis. 2021;8(9):101. doi:10.3390/jcdd8090101.

Turgeon RD, Barry AR, Hawkins NM, Ellis UM. Pharmacotherapy for HFrEF & quality of life: systematic review & meta-analysis. Eur J Heart Fail. 2021;23(4):578-89. doi:10.1002/ejhf.2141.

Tromp J, Ouwerkerk W, van Veldhuisen DJ, Hillege HL, Richards AM, van der Meer P, et al. Network meta-analysis of pharmacologic treatment for HFrEF. JACC Heart Fail. 2022;10(2):73-84. doi:10.1016/j.jchf.2021.09.004.

Ziff OJ, Samra M, Howard JP, Bromage DI, Ruschitzka F, Francis DP, et al. Beta-blocker efficacy across cardiovascular indications: umbrella review. BMC Med. 2020;18(1):103. doi:10.1186/s12916-020-01564-3.

Irtaza A, Junaid M, Saqlain M, Akram A, Khan A, Sarwari AS, et al. Beta-blockers post-MI in PCI era: systematic review & meta-analysis. medRxiv. 2024:24313821. doi:10.1101/2024.09.18.24313821.

Lin Y, Wu M, Liao B, Pang X, Chen Q, Yuan J, et al. Network meta-analysis for long-term outcomes in HFpEF. Front Pharmacol. 2021;12:707777. doi:10.3389/fphar.2021.707777.

Tao S, Huang J, Xiao J, Ke G, Fu P. Cardio-selective vs non-selective β-blockers in dialysis patients: systematic review & meta-analysis. PLoS One. 2022;17(12):e0279171. doi:10.1371/journal.pone.0279171.

Teo YH, Yoong CSY, Syn NL, Teo YN, Cheong JYA, Lim YC, et al. Comparison of SGLT2 inhibitors in HF: network meta-analysis. Eur J Clin Pharmacol. 2021;77(10):1453-64. doi:10.1007/s00228-021-03147-4.

Hasegawa D, Sato R, Prasitlumkum N, Nishida K, Takahashi K, Yatabe T, et al. Ultrashort-acting β-blockers in sepsis with persistent tachycardia: meta-analysis. Chest. 2021;159(6):2289-300. doi:10.1016/j.chest.2021.01.009.

Fukuta H, Goto T, Kamiya T. Calcium channel blockers in HFpEF: systematic review protocol. PLoS One. 2024;19(8):e0307258. doi:10.1371/journal.pone.0307258.

Alotaibi S, Hernandez-Montfort J, Ali OE, El-Chilali K, Perez BA. Remote monitoring of implantable cardiac devices in HF: systematic review & meta-analysis. Heart Fail Rev. 2020;25(3):469-79. doi:10.1007/s10741-020-09923-1.

Niriayo YL, Asgedom SW, Demoz GT, Gidey K. Treatment optimization of beta-blockers in chronic HF. Sci Rep. 2020;10(1):15903. doi:10.1038/s41598-020-72836-4.