Effect of beta-blocker therapy on functional status in patients with heart failure -- A meta-analysis

doi:10.1016/j.ejheart.2005.10.012

European Journal of Heart Failure 2006 8(5):522-531; doi:10.1016/j.ejheart.2005.10.012

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Effect of beta-blocker therapy on functional status in patients with heart failure — A meta-analysis

Jawdat Abdulla^a^,*, Lars Køber^b, Erik Christensen^c and Christian Torp-Pedersen^d

^a Department of Cardiology, Gentofte University Hospital Copenhagen, Denmark
^b Rigshospitalet Heart Centre, Department of Medicine, Division of Cardiology Copenhagen, Denmark
^c Department of Medicine, Bispebjerg University Hospital Copenhagen, Denmark
^d Department of Cardiology, Bispebjerg University Hospital Copenhagen, Denmark

^* Corresponding author. Fax: +45 39760107. E-mail address: ja{at}heart.dk

Abstract

Background: The results of randomised control trials (RCTs) evaluating theeffect of beta-blockers on functional status in patients withchronic heart failure are conflicting.

Aim: To perform a systematic review and meta-analysis of RCTs evaluatingthe effect of beta-blockers on New York Heart Association (NYHA)classification and exercise tolerance in chronic heart failure.

Methods and results: We selected 28 RCTs evaluating beta-blocker versus placebo inaddition to ACE inhibitor therapy. Combined results of 23 RCTsshowed that beta-blockers improved NYHA class by at least oneclass with odds ratio (OR) 1.80 (1.33–2.43) p<0.0001.Meta-analysis of 10 RCTs showed a significant prolongation ofexercise time by 44.19 (6.62–81.75) s p=0.021. Combining8 RCTs evaluating the maximal peak oxygen uptake and 9 RCTsevaluating 6-min walk distance showed that beta-blockers hadno significant effect compared with placebo, p=0.484, and p=0.730,respectively. Combined results of the 23 RCTs showed significantreducing effect on all cause mortality with OR=0.69 (0.59–0.82)p<0.0001.

Conclusion: Chronic use of a beta-blocker in conjunction with ACE inhibitortherapy improves dyspnoea and prolongs exercise tolerance time,but has no significant effect on 6-min walk test or maximaloxygen uptake in patients with heart failure.

Key Words: Congestive heart failure • Left ventricular dysfunction • Beta-adrenergic blocker • Angiotensin converting enzyme inhibitor

Received April 28, 2005; Revised June 25, 2005; Accepted October 17, 2005

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