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Beta blockers show real-life mortality benefit in HF with AF

Heart Failure 2016 Congress News

Morten Schou, Herlev and Gentofte Hospital, Herlev, Denmark

Clinical Forum; 21 May, 08:30–17:30; Poster Area

Beta blockers reduce mortality risk by 20% over 5 years in heart failure patients with atrial fibrillation in a real-life setting, Danish researchers have discovered in findings that contradict those of a recent meta-analysis.

Beta blockers are the standard of care in the treatment of heart failure with reduced ejection fraction. However, Kotecha et al found that the drugs did not reduce mortality rates in patients with concomitant heart failure and atrial fibrillation. [1]

Speaking to Heart Failure Congress News, lead researcher Morten Schou (Herlev and Gentofte Hospital, Herlev, Denmark) said that this finding was “quite provocative” and that he and his colleagues therefore “wanted to look into our registries to see what we observe in real life.”

They used data from the Danish National Patient Registry and the National Prescription Registry to identify all patients with heart failure and atrial fibrillation who claimed prescriptions between 1996 and 2012.

Of 11,112 patients identified, 5922 were treated with beta blockers at baseline. The researchers then performed a propensity matched analysis of 4305 beta blocker patients and the same number of non-beta blocker patients matched for age, sex, loop diuretic dose, comorbidities and baseline medications.

Over a 5 years, beta blocker use was associated with a significant reduction in mortality, at 39.9% versus 44.7% among non-beta blocker patients, or a hazard ratio of 0.80. This was largely driven by carvedilol and metropolol, rather than bisoprolol.

Dr Schou said that it is not clear why the previous meta-analysis did not pick up the survival benefit they identified in the registry data.

“If we really want to clarify the issue…we have to conduct a prospective, multi-centre, randomised clinical trial,” he noted, adding: “We can do a lot of small, mechanistic studies, and we can do post-hoc analyses of clinical trials or observational propensity matched studies, but they have confounding and biases challenges, which we cannot eliminate.”

Interestingly, there was no reduction in atrial fibrillation or heart failure readmissions with beta blockers, at 63.9% versus 59.1% in the non-beta blocker group (hazard ratio 1.06).

“If we had observed a reduction in admissions for heart failure or atrial fibrillation that could be a signal that it was the way the mortality risk was reduced,” Dr Schou said. However, the “problem” with conducting a registry analysis is that of competing risks, thus underlying the need for a randomised clinical trial.

Dr Schou concluded: “But will such a trial ever be conducted? I don’t know.”


  1. Kotecha D, Holmes J, Krum H et al. Efficacy of β blockers in patients with heart failure plus atrial fibrillation: an individual-patient data meta-analysis. Lancet 2014; 384: 2235–2243.

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