Effect of beta-blocker therapy on functional status in patients with heart failure--a meta-analysis.
BACKGROUND
The results of randomised control trials (RCTs) evaluating the effect of beta-blockers on functional status in patients with chronic heart failure are conflicting.


OBJECTIVE
To perform a systematic review and meta-analysis of RCTs evaluating the effect of beta-blockers on New York Heart Association (NYHA) classification and exercise tolerance in chronic heart failure.


RESULTS
We selected 28 RCTs evaluating beta-blocker versus placebo in addition to ACE inhibitor therapy. Combined results of 23 RCTs showed that beta-blockers improved NYHA class by at least one class with odds ratio (OR) 1.80 (1.33-2.43) p<0.0001. Meta-analysis of 10 RCTs showed a significant prolongation of exercise time by 44.19 (6.62-81.75) s p=0.021. Combining 8 RCTs evaluating the maximal peak oxygen uptake and 9 RCTs evaluating 6-min walk distance showed that beta-blockers had no significant effect compared with placebo, p=0.484, and p=0.730, respectively. Combined results of the 23 RCTs showed significant reducing effect on all cause mortality with OR=0.69 (0.59-0.82) p<0.0001.


CONCLUSIONS
Chronic use of a beta-blocker in conjunction with ACE inhibitor therapy improves dyspnoea and prolongs exercise tolerance time, but has no significant effect on 6-min walk test or maximal oxygen uptake in patients with heart failure.
Abdulla
Jawdat
J
Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark. ja@heart.dk
Køber
Lars
L
Christensen
Erik
E
Torp-Pedersen
Christian
C
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D005080:Exercise Test; D017079:Exercise Tolerance / Q000187:drug effects; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology*; D006801:Humans; D010101:Oxygen Consumption / Q000187:drug effects; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
D000319:Adrenergic beta-Antagonists