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

Published: 16-09-2019| Version 1 | DOI: 10.17632/scjbzk4tkh.1
Contributors:
Jeness Campodonico,
Massimo Piepoli,
Francesco Clemenza,
Alice Bonomi,
Stefania Paolillo,
Elisabetta Salvioni,
Ugo Corra,
Simone Binno,
Fabrizio Veglia,
Rocco Lagioia,
Gianfranco Sinagra,
Gaia Cattadori,
Angela Beatrice Scardovi,
Marco Metra,
Michele Senni,
Domenico Scrutinio,
Rosa Raimondo,
Michele Emdin,
Damiano Magrì,
Gianfranco Parati,
Federica Re,
Mariantonietta Cicoira,
Chiara Minà,
Giuseppe Limongelli,
Michele Correale,
Maria Frigerio,
Maurizio Bussotti,
Enrico Perna,
Elisa Battaia,
Marco Guazzi,
Roberto Badagliacca,
Andrea Di Lenarda,
Aldo Maggioni,
Claudio Passino,
Susanna Sciomer,
Giuseppe Pacileo,
Massimo Mapelli,
Carlo Vignati,
Carolina Lombardi,
Pasquale Perrone Filardi,
piergiuseppe agostoni

Description

BACKGROUND: The usefulness of β-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 AF enrolled in the MECKI score database. We evaluated prognosis (composite of cardiovascular death, urgent heart transplant, or left ventricular assist device) of patients receiving β-blockers (n = 777, 81%) vs. those not treated with β-blockers (n = 181, 19%). We also analyzed the role β1-selectivity and the role of daily β-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 β-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 β-blockers had a better outcome (HR 0.447, p < 0.01) with no effects as regards β1selective drugs (53%) vs. β1-β2 blockers (47%). Survival improved in parallel with β-blocker dose increase (HR 0.296, 0.496, 0.490 for the high, medium, and low dose vs. no β-blockers, p < 0.0001). CONCLUSION: HF patients with AF taking a β-blocker have a better outcome (with a survival improvement in parallel with daily dose but no differences as regards β1 selectivity) but this does not mean that β-blockers improve outcomes in these patients as we cannot control for all the potential confounders associated with β-blocker use.

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