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European Journal of Heart Failure 2007 9(11):1136-1139; doi:10.1016/j.ejheart.2007.09.003
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© 2007 European Society of Cardiology

Comparison of the beneficial effect of beta-blockers on mortality in patients with ischaemic or non-ischaemic systolic heart failure: A meta-analysis of randomised controlled trials

Laurent Fauchier*, Bertrand Pierre, Axel de Labriolle and Dominique Babuty

Cardiologie, Centre Hospitalier Universitaire Trousseau 37044 Tours
Université François-Rabelais 37032 Tours, France

* Corresponding author. Service de Cardiologie B et Laboratoire d'Electrophysiologie Cardiaque, Pole Cœur Thorax Vasculaire Hémostase, Centre Hospitalier Universitaire Trousseau, 37044 Tours, France. Tel.: +33 2 47 47 46 50; fax: +33 2 47 47 59 19. E-mail address: lfau{at}med.univ-tours.fr


  Abstract

Mechanisms by which beta-blockers bring benefit may differ according to the aetiology of heart failure (HF). It is uncertain whether the magnitude of the benefit of beta-blockers is the same in ischaemic or non-ischaemic HF.

Methods: We performed a systematic review of all randomised, placebo-controlled, parallel-design trials of beta-blockers in HF that collected data on mortality during follow-up.

Results: Among 26 randomised trials comparing beta-blockers with placebo in HF, 4 studies with 7250 patients provided information on the number of patients who died during follow-up in subgroups of ischaemic and non-ischaemic aetiology of HF. Two studies were performed with bisoprolol, one with carvedilol and one with metoprolol. HF was associated with ischaemic aetiology in 4746/7250 patients (65%) and non-ischaemic aetiology in 2504/7250 patients (35%). Mortality occurred in 301 patients. The risk ratio (RR) for beta-blockers versus placebo was 0.62 (95% confidence interval [CI] 0.52–0.75, p<0.00001) in ischaemic HF, compared with a RR of 0.62 (95% CI 0.45–0.84, p=0.002) in the presence of non-ischaemic HF.

Conclusion: The magnitude of the prognostic benefit conferred by beta-blockers for overall mortality in non-ischaemic HF appears to be very similar to that in ischaemic HF.

Key Words: Heart failure • Beta-blockers • Coronary artery disease • Dilated cardiomyopathy

Received July 3, 2007; Revised August 18, 2007; Accepted September 11, 2007


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