SOURCE: Lund LH, et al. Association between use of beta-blockers and outcomes in patients with heart failure and preserved ejection fraction. JAMA 2014;312:2008-2018.
Despite the consistent success of ACE inhibitors, angiotensin II receptor blockers, beta-blockers, and aldosterone antagonists in chronic heart failure from systolic dysfunction (s-CHF), trials of pharmacotherapy for chronic heart failure from diastolic dysfunction (d-CHF) have been disappointing. Modestly encouraging results for d-CHF were seen with candesartan (Atacand) in the CHARM-PRESERVED trial and nebivolol (Bystolic) in the SENIORS trial (for the d-CHF subgroup), but neither trial had strong enough outcomes to definitively establish a role in CHF.
Lund et al report on data obtained from national data registries in Sweden inclusive of 19,083 patients with d-CHF (termed “heart failure with preserved ejection fraction” in this article). The registry (41,976 patients) allowed comparison of patients who had been treated with beta-blockers vs those who had not by propensity scores. The primary outcome of the study was all-cause mortality.
Five-year survival in d-CHF was 7% higher in patients who were treated with beta-blockers. Because these data are observational in nature, they cannot definitively establish whether beta-blocker treatment reduces mortality in d-CHF, but they provide strong impetus to perform a large randomized trial to ultimately answer the question.