title: β-Blockers for the prevention of sudden cardiac death in heart failure patients: a meta-analysis of randomized controlled trials.
abstract: BACKGROUND
  In many studies, beta-blockers have been shown to decrease sudden cardiac death (SCD) in heart failure patients; other studies reported mixed results. Recently, several large randomized control trials of beta blockers have been carried out. It became necessary to conduct a systematic review to provide an up-to-date synthesis of available data.
  
  
  METHODS
  We conducted a meta-analysis of all randomized controlled trials examining the use of beta-blockers vs. placebo/control for the prevention of SCD in heart failure patients. We identified 30 trials, which randomized 24,779 patients to beta-blocker or placebo/control. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Eligible studies had to be randomized controlled trials and provide information on the incidence of sudden cardiac death in heart failure patients. Additional inclusion criteria included: treatment for >30 days and follow-up≥3 months. Studies of patients<18 years, randomization to beta-blocker vs. an angiotensin converting enzyme (without placebo) and/or beta-blocker in both arms were excluded from the analysis. Pre-specified outcomes of interest included SCD, cardiovascular death (CVD), and all-cause mortality and were analyzed according to intention-to-treat.
  
  
  RESULTS
  We found that beta-blockers are effective in the prevention of SCD [OR 0.69; 95% CI, 0.62-0.77, P<0.00001], cardiovascular death (CVD) [OR 0.71; 95% CI, 0.64-0.79, P<0.00001], and all-cause mortality [OR 0.67; 95% CI, 0.59-0.76, P<0.00001]. Based on the study analysis, 43 patients must be treated with a beta-blocker to prevent one SCD, 26 patients to prevent one CVD and 21 patients to prevent all-cause mortality in one year.
  
  
  CONCLUSIONS
  Beta-blockers reduce the risk of sudden cardiac death (SCD) by 31%, cardiovascular death (CVD) by 29% and all-cause mortality by 33%. These results confirm the mortality benefits of these drugs and they should be recommended to all patients similar to those included in the trials.
authors.affiliation: Laboratoire de Biologie et Biométrie Evolutive-Equipe Modélisation des Effets Thérapeutiques, UMR 5558 Université Claude Bernard Lyon1, Rue Guillaume Paradin, Bp8071, 69376 Lyon Cedex 08, France. muaamar.algobari@gmail.com
authors.forename: Muaamar
authors.initials: M
authors.lastname: Al-Gobari
authors.forename: Chadia
authors.initials: C
authors.lastname: El Khatib
authors.forename: François
authors.initials: F
authors.lastname: Pillon
authors.forename: François
authors.initials: F
authors.lastname: Gueyffier
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000517:prevention & control*; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality*; D006801:Humans; D016032:Randomized Controlled Trials as Topic / Q000379:methods* / Q000401:mortality*; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists