Atrial fibrillation (AF) and heart failure (HF) are two increasingly prevalent conditions that often coexist. Beta-blockers are a mainstay in the treatment of HF with reduced ejection fraction (HFrEF). However, does the presence of AF influence the benefit of beta-blockers in patients with HFrEF?
To answer this question, Dr Dipak Kotecha (University of Birmingham, United Kingdom) and his colleagues analyzed data from 10 randomized controlled trials that compared beta-blockers and placebo in patients with HFrEF. Only studies that included data on all-cause mortality and had a minimum of 300 patients and at least six months of follow-up were included in the analysis. Results of the analysis, which included 18,254 patients, 3,066 of whom had AF, were presented at the European Society of Cardiology 2014 Congress.
Their analysis showed that, after a mean follow-up of 1.5 years, the mortality among non-AF patients was 16% vs 21% in those with AF. Furthermore, beta-blockers were associated with a 27% reduction in all-cause death among patients without AF. However, among patients with AF, no mortality reduction was found, as a whole, or in any subgroup analyses (by age, sex, LVEF, NYHA class, heart rate, and other medical therapies).
Additionally, beta-blocker use was associated with reductions in cardiovascular (CV) death, first CV hospital admission, and first HF-related hospital admission in those without AF. But in those with AF, no benefit was found in these outcomes.
While Kotecha recommended that a large randomized trial should still be conducted to confirm these findings, he also recommended that "Based on our findings, beta-blockers should not be used preferentially over other rate-control medications and not regarded as standard therapy to improve prognosis in patients with concomitant HF and AF."
Lastly, he noted that there seemed to be "no signal of harm" seen with beta-blockers in patients with AF, suggesting that these patients may still receive beta-blockers for other indications.