© 2001 European Society of Cardiology
Systematic review of the impact of beta blockers on mortality and hospital admissions in heart failure
a Clinical Trials and Evaluation Unit, Royal Brompton and Harefield NHS Trust Sydney Street, SW3 6NP, London, UK
b Imperial College of Science Technology and Medicine London, UK
c London School of Hygiene and Tropical Medicine London, UK
* Corresponding author. Tel.: +44-20-7351 8827; fax: +44-20-7351 8829 E-mail address: m.shibata{at}rbh.nthames.nhs.uk (M.C. Shibata).
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Abstract |
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Heart failure is a common condition that carries a high burden of mortality and morbidity. Several randomised trials have evaluated the effects of beta blockers in heart failure. This paper gives a systematic overview of published randomised trials of beta blockers in heart failure using standard methods. In all, 22 randomised controlled trials were identified with a total of 10480 patients, and an average of 11 months of treatment. The average age was 61 years and 4% were female. Most studies excluded patients with severe heart failure. Death rates in patients randomised to receive beta blockers compared to controls were 458/5657 (8.0%) and 635/4951 (12.8%) respectively, odds ratio 0.63, 95% CI 0.55–0.72, P < 0.00001. Similar reductions were observed for hospital admissions for worsening heart failure (11.3 vs. 17.1%, respectively, odds ratio 0.63) and for the composite outcome of death or heart-failure hospital admission (19.4 vs. 26.9%, respectively, odds ratio 0.66). These results show that beta blockers reduce the risk of mortality or the need for heart-failure hospital admission by approximately one third. Absolute reductions of 5–6% in event rates were observed over approximately 1 year of treatment period. These important benefits should be implemented as a priority, since treatment with beta blockers is inexpensive and heart failure carries a high risk of death and disability. Further information on the effect of beta blockers in elderly patients and women would be helpful.
Key Words: Beta blocker • Heart failure • Meta-analysis • Randomised controlled trial • Systematic review
Received August 4, 2000; Revised February 2, 2001; Accepted February 12, 2001
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