title: Benefits of β blockers in patients with heart failure and reduced ejection fraction: network meta-analysis.
abstract: OBJECTIVE
  To clarify whether any particular β blocker is superior in patients with heart failure and reduced ejection fraction or whether the benefits of these agents are mainly due to a class effect.
  
  
  METHODS
  Systematic review and network meta-analysis of efficacy of different β blockers in heart failure.
  
  
  METHODS
  CINAHL(1982-2011), Cochrane Collaboration Central Register of Controlled Trials (-2011), Embase (1980-2011), Medline/PubMed (1966-2011), and Web of Science (1965-2011).
  
  
  METHODS
  Randomized trials comparing β blockers with other β blockers or other treatments.
  
  
  METHODS
  The primary endpoint was all cause death at the longest available follow-up, assessed with odds ratios and Bayesian random effect 95% credible intervals, with independent extraction by observers.
  
  
  RESULTS
  21 trials were included, focusing on atenolol, bisoprolol, bucindolol, carvedilol, metoprolol, and nebivolol. As expected, in the overall analysis, β blockers provided credible mortality benefits in comparison with placebo or standard treatment after a median of 12 months (odds ratio 0.69, 0.56 to 0.80). However, no obvious differences were found when comparing the different β blockers head to head for the risk of death, sudden cardiac death, death due to pump failure, or drug discontinuation. Accordingly, improvements in left ventricular ejection fraction were also similar irrespective of the individual study drug.
  
  
  CONCLUSIONS
  The benefits of β blockers in patients with heart failure with reduced ejection fraction seem to be mainly due to a class effect, as no statistical evidence from current trials supports the superiority of any single agent over the others.
authors: Division of Internal Medicine, Maimonides Medical Center, New York, NY, USA. sauravchatterjeemd@gmail.com
authors: Saurav
authors: S
authors: Chatterjee
authors: Giuseppe
authors: G
authors: Biondi-Zoccai
authors: Antonio
authors: A
authors: Abbate
authors: Fabrizio
authors: F
authors: D'Ascenzo
authors: Davide
authors: D
authors: Castagno
authors: Benjamin
authors: B
authors: Van Tassell
authors: Debabrata
authors: D
authors: Mukherjee
authors: Edgar
authors: E
authors: Lichstein
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D001499:Bayes Theorem; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D016017:Odds Ratio; D016032:Randomized Controlled Trials as Topic; D013318:Stroke Volume; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists