Background: The usefulness of beta-blockers in heart failure (HF) patients with permanent atrial fibrillation (AF) has been questioned.Methods and results: We analyzed data from HF patients (958 patients (801 males, 84%, age 67 +/- 11 years)) with AI enrolled in the MECKI score database. We evaluated prognosis (composite of cardiovascular death, urgent heart transplant, or left ventricular assist device) of patients receiving beta-blockers (n = 777, 81%) vs. those not treated with beta-blockers (n = 181, 19%). We also analyzed the role beta 1-selectivity and the role of daily beta-blocker dose. To account for different HF severity, Kaplan-Meier survival curves were normalized for relevant confounding factors and for treatment strategies. Dose was available in 629 patients. Median follow-up was 1312 (577-2304) days in the entire population, 1203 (614-2420) and 1325 (569-2300) days in patients not receiving and receiving beta-blockers. 224 (23%, 54/1000 events/year), 163 (21%, 79/1000 events/year), and 61 (34%. 49/1000 events/year) events were recorded, respectively. At 10-year patients treated with beta-blockers had a better outcome (HR 0.447. p < 0.01) with no effects as regards beta 1-selective drugs (53%) vs. beta 1-beta 2 blockers (47%). Survival improved in parallel with beta-blocker dose increase (HR 0.296, 0.496. 0.490 for the high, medium, and low dose vs. no beta-blockers, p < 0.0001).Conclusion: HF patients with AF taking a beta-blocker have a better outcome (with a survival improvement in parallel with daily dose but no differences as regards beta 1 selectivity) but this does not mean that ii-blockers improve outcomes in these patients as we cannot control for all the potential confounders associated with beta-blocker use. (C) 2018 Published by Elsevier B.V.

Dose-dependent efficacy of β-blocker in patients with chronic heart failure and atrial fibrillation

Cicoira, Mariantonietta;Battaia, Elisa;
2018-01-01

Abstract

Background: The usefulness of beta-blockers in heart failure (HF) patients with permanent atrial fibrillation (AF) has been questioned.Methods and results: We analyzed data from HF patients (958 patients (801 males, 84%, age 67 +/- 11 years)) with AI enrolled in the MECKI score database. We evaluated prognosis (composite of cardiovascular death, urgent heart transplant, or left ventricular assist device) of patients receiving beta-blockers (n = 777, 81%) vs. those not treated with beta-blockers (n = 181, 19%). We also analyzed the role beta 1-selectivity and the role of daily beta-blocker dose. To account for different HF severity, Kaplan-Meier survival curves were normalized for relevant confounding factors and for treatment strategies. Dose was available in 629 patients. Median follow-up was 1312 (577-2304) days in the entire population, 1203 (614-2420) and 1325 (569-2300) days in patients not receiving and receiving beta-blockers. 224 (23%, 54/1000 events/year), 163 (21%, 79/1000 events/year), and 61 (34%. 49/1000 events/year) events were recorded, respectively. At 10-year patients treated with beta-blockers had a better outcome (HR 0.447. p < 0.01) with no effects as regards beta 1-selective drugs (53%) vs. beta 1-beta 2 blockers (47%). Survival improved in parallel with beta-blocker dose increase (HR 0.296, 0.496. 0.490 for the high, medium, and low dose vs. no beta-blockers, p < 0.0001).Conclusion: HF patients with AF taking a beta-blocker have a better outcome (with a survival improvement in parallel with daily dose but no differences as regards beta 1 selectivity) but this does not mean that ii-blockers improve outcomes in these patients as we cannot control for all the potential confounders associated with beta-blocker use. (C) 2018 Published by Elsevier B.V.
Cardiopulmonary exercise test; Prognosis; β-Blockers, Atrial fibrillation
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11562/1030260
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