Background: β-Blockers have an uncertain effect in heart failure with a preserved ejection fraction of 50% or higher (heart failure with preserved ejection fraction [HFpEF]). Methods and Results: We included patients with HFpEF from the Swedish Heart Failure Registry (SwedeHF) enrolled from 2011 through 2018. In a 2:1 propensity-score matched analysis (β-blocker use vs nonuse), we assessed the primary outcome first HF hospitalization, the coprimary outcome cardiovascular (CV) death, and the secondary outcomes of all-cause hospitalization and all-cause death. We performed intention-to-treat and a per-protocol consistency analyses. There were a total of 14,434 patients (median age 79 years, IQR 71–85 years, 51% women); 80% were treated with a β-blocker at baseline. Treated patients were younger and had higher rates of atrial fibrillation and coronary artery disease, and higher N-terminal pro-B-type natriuretic peptide levels. In the 4412:2206 patient matched cohort, at 5 years, 42% (95% CI 40%–44%) vs 44% (95% CI 41%–47%) had a HF admission and 38% (IQR 36%–40%) vs 40% (IQR 36%–42%) died from CV causes. In the intention-to-treat analysis, β-blocker use was not associated with HF admissions (hazard ratio 0.95 [95% CI 0.87–1.05, P =.31]) or CV death (hazard ratio 0.94 [95% CI 0.85–1.03, P =.19]). In the subgroup analyses, men seemed to have a more favorable association between β-blockers and outcomes than did women. There were no associations between β-blocker use and secondary outcomes. Conclusions: In patients with HFpEF, β-blocker use is common but not associated with changes in HF hospitalization or cardiovascular mortality. In the absence of a strong rational and randomized control trials the case for β-blockers in HFpEF remains inconclusive. Bullet points: ● The effect of β-blockers with heart failure with preserved ejection fraction of 50% or greater is uncertain.● In a propensity score–matched heart failure with preserved ejection fraction analysis in the SwedeHF registry, β-blockers were not associated with a change in risk for heart failure admissions or cardiovascular deaths. Lay summary: The optimal treatment for heart failure with a preserved pump function remains unknown. Despite the lack of scientific studies, β-blockers are very commonly used. When matching patients with a similar risk profile in a large heart failure registry, the use of β-blockers for the treatment of heart failure with a preserved pump function was not associated with any changes in heart failure hospital admissions or cardiovascular death.
Bibliographical noteFunding Information:
Dr Meyer reported having licensed patents on the use of pacemakers to prevent and treat heart failure with preserved ejection fraction, outside the submitted work. Dr. Lund reports research grants from AstraZeneca, Novartis, Boehringer Ingelheim, Vifor-Fresenius, and Boston Scientific, and consulting or speaker's honoraria from AstraZeneca, Novartis, Boehringer Ingelheim, Vifor-Fresenius, Bayer, Sanofi, Merck, Myokardia, Orion Pharma, MedScape, Radcliffe Cardiology, Lexicon, and Respicardia, and stock ownership in AnaCardio, outside the submitted work. Dr Dahlström reports research grants from Boehringer Ingelheim, Pfizer, AstraZeneca, Boston Scientific, Vifor Pharma and Roche Diagnostics and consulting or speaker´s honoraria from AstraZeneca, Novartis and Amgen, outside the submitted work. Dr. Savarese reports grants and personal fees from Vifor, grants and non-financial support from Boehringer Ingelheim, personal fees from Societa´ Prodotti Antibiotici, grants and personal fees from AstraZeneca, personal fees from Roche, personal fees from Servier, grants from Novartis, personal fees from GENESIS, personal fees from Cytokinetics, personal fees from Medtronic, grants from Boston Scientific, outside the submitted work.
Supported by the EU/EFPIA Innovative Medicines Initiative 2 Joint Undertaking BigData@Heart grant [n° 116074]; the Swedish Research Council [grant 523-2014-2336]; and the Swedish Heart Lung Foundation [grants 20150557 and 20170841] in the form of grants to LHL. Dr. Meyer was supported by grant R01 HL-122744 from the National Institutes of Health.
© 2021 Elsevier Inc.
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