title: Effect of nebivolol on outcome in elderly patients with heart failure and atrial fibrillation: insights from SENIORS.
abstract: OBJECTIVE
  Beneficial effects of beta-blockade remain unclear in heart failure patients who have atrial fibrillation (AF), especially in the elderly. We evaluated the effect of nebivolol on cardiovascular outcomes in elderly patients with heart failure and AF.
  
  
  RESULTS
  The SENIORS trial showed an overall benefit of nebivolol compared with placebo in 2128 heart failure patients >70 years of age. At baseline, AF was present in 738 (34.7%) patients. The primary outcome was all-cause mortality or cardiovascular hospitalizations. After 21 months, the cumulative incidence of the primary outcome was significantly more common in patients with AF compared with those with sinus rhythm (38.5% vs. 30.4%, respectively, P < 0.001). In patients with AF, nebivolol had no beneficial effect on the primary outcome [nebivolol vs. placebo, 37.1% vs. 39.8%, hazard ratio (HR) 0.92, 95% confidence interval (CI), 0.73-1.17, P = 0.46], in contrast to patients with sinus rhythm (28.1% vs. 32.9%, in the nebivolol vs. placebo group, respectively, HR 0.82, 95% CI 0.67-0.99, P = 0.049). In patients with AF, the primary outcome was similar in the impaired and preserved left ventricular ejection fraction (LVEF) groups (39.0% with LVEF ≤ 35% vs. 37.3% in patients with LVEF > 35%). There was also no evidence of benefit of nebivolol in AF patients stratified by LVEF.
  
  
  CONCLUSIONS
  Nebivolol failed to improve outcomes in elderly patients with stable heart failure and co-existing AF, irrespective of LVEF. Furthermore, in patients with AF, outcome was comparable between patients with preserved and impaired LVEF.
authors: Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherland.
authors: Bart A
authors: BA
authors: Mulder
authors: Dirk J
authors: DJ
authors: van Veldhuisen
authors: Harry J G M
authors: HJ
authors: Crijns
authors: Michael
authors: M
authors: Böhm
authors: Alain
authors: A
authors: Cohen-Solal
authors: Daphne
authors: D
authors: Babalis
authors: Michael
authors: M
authors: Roughton
authors: Marcus D
authors: MD
authors: Flather
authors: Andrew J S
authors: AJ
authors: Coats
authors: Isabelle C
authors: IC
authors: Van Gelder
mesh_terms: D058671:Adrenergic beta-1 Receptor Antagonists / Q000627:therapeutic use*; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000150:complications* / Q000401:mortality; D001578:Benzopyrans / Q000627:therapeutic use*; D004311:Double-Blind Method; D004983:Ethanolamines / Q000627:therapeutic use*; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000188:drug therapy / Q000401:mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D000068577:Nebivolol; D013318:Stroke Volume; D016896:Treatment Outcome
chemical_list: D058671:Adrenergic beta-1 Receptor Antagonists; D001578:Benzopyrans; D004983:Ethanolamines; D000068577:Nebivolol