Prevention of atrial fibrillation onset by beta-blocker treatment in heart failure: a meta-analysis.
OBJECTIVE
Atrial fibrillation (AF) is an important morbidity-mortality risk factor, especially in patients with heart failure (HF). Beta-blockers reduce morbidity and mortality in HF. The study was designed to estimate the preventive efficacy of beta-blocker treatment on AF occurrence in patients with HF.


RESULTS
A systematic review of the literature was performed to identify all clinical trials evaluating beta-blockers' efficacy in HF. Eligible studies had to be randomized, placebo-controlled and providing information on the incidence of AF during follow-up among those with sinus rhythm at baseline. A total of seven studies which included 11 952 patients receiving a background treatment with angiotensin-converting enzyme-inhibitors could be found. Overall, beta-blockers significantly reduced incidence of onset of AF from 39 to 28 per 1000 patient-years: relative risk reduction=27% (95% confidence interval 14-38, P<0.001); heterogeneity test: P=0.096. A same trend of efficacy was observed in all trials except the SENIORS study. In this trial which included aged patients (>70 years) with systolic or diastolic HF, a higher prevalence of AF at baseline (35%) was observed compared with the mean baseline prevalence (13%).


CONCLUSIONS
Beta-blockers appear to effectively prevent occurrence of AF in patients with systolic HF.
Nasr
Imad Abi
IA
Clinical Pharmacology Department, La Pitié Salpetrière Hospital, Assistance Publique-Hôpitaux de Paris, 47 Boulevard de l'Hôpital, 75013 Paris, and Cardiology Department, Hôpital Universitaire Ambroise Paré, Boulogne, France. imad.abi-nasr@apr.aphp.fr
Bouzamondo
Anissa
A
Hulot
Jean-Sébastien
JS
Dubourg
Olivier
O
Le Heuzey
Jean-Yves
JY
Lechat
Philippe
P
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D001281:Atrial Fibrillation / Q000209:etiology / Q000517:prevention & control*; D002908:Chronic Disease; D004311:Double-Blind Method; D006333:Heart Failure / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic
D000319:Adrenergic beta-Antagonists