Comparison of the beneficial effect of beta-blockers on mortality in patients with ischaemic or non-ischaemic systolic heart failure: a meta-analysis of randomised controlled trials.
Mechanisms by which beta-blockers bring benefit may differ according to the aetiology of heart failure (HF). It is uncertain whether the magnitude of the benefit of beta-blockers is the same in ischaemic or non-ischaemic HF.


METHODS
We performed a systematic review of all randomised, placebo-controlled, parallel-design trials of beta-blockers in HF that collected data on mortality during follow-up.


RESULTS
Among 26 randomised trials comparing beta-blockers with placebo in HF, 4 studies with 7250 patients provided information on the number of patients who died during follow-up in subgroups of ischaemic and non-ischaemic aetiology of HF. Two studies were performed with bisoprolol, one with carvedilol and one with metoprolol. HF was associated with ischaemic aetiology in 4746/7250 patients (65%) and non-ischaemic aetiology in 2504/7250 patients (35%). Mortality occurred in 301 patients. The risk ratio (RR) for beta-blockers versus placebo was 0.62 (95% confidence interval [CI] 0.52-0.75, p<0.00001) in ischaemic HF, compared with a RR of 0.62 (95% CI 0.45-0.84, p=0.002) in the presence of non-ischaemic HF.


CONCLUSIONS
The magnitude of the prognostic benefit conferred by beta-blockers for overall mortality in non-ischaemic HF appears to be very similar to that in ischaemic HF.
Fauchier
Laurent
L
Cardiologie, Centre Hospitalier Universitaire Trousseau, 37044 Tours, France. lfau@med.univ-tours.fr
Pierre
Bertrand
B
de Labriolle
Axel
A
Babuty
Dominique
D
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality* / Q000503:physiopathology; D006801:Humans; D017202:Myocardial Ischemia / Q000188:drug therapy* / Q000401:mortality* / Q000503:physiopathology; D016032:Randomized Controlled Trials as Topic
D000319:Adrenergic beta-Antagonists