Beta-blocker use and cardiovascular event risk in patients with heart failure with preserved ejection fraction

Abstract

To assess whether beta-blocker use is associated with cardiovascular events and mortality in patients with heart failure with preserved ejection fraction (HFpEF), this study analyzed the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial data using Cox proportional hazard models. Adjusted HRs for composite cardiovascular events in all patients and in patients without previous MI were significantly higher for those on beta-blockers than for those not on beta-blockers (Hazard ratio [HR] for all patients 1.23, 95% confidence interval [95% CI] 1.02-1.49; HR for patients without previous MI 1.35, 95% CI 1.08-1.70), whereas that for patients with previous MI was not significantly different (HR 1.06, 95% CI 0.74-1.54). Additionally, cardiovascular event risk in propensity score-matched patients without previous MI was significantly higher in those on beta-blockers than in those not on beta-blockers. Risks of all-cause death, major cardiovascular events, and heart failure hospitalization were significantly higher in those on beta-blockers than in those not on beta-blockers. Beta-blocker use in HFpEF patients, particularly those without previous MI, was associated with increased risk of unfavorable cardiovascular events.

Figure 1

Kaplan–Meier survival curves for primary outcome events. Rates of freedom from primary outcome events in all study patients (A), patients without a history of MI (B), and patients with a history of MI (C). The primary outcome was a composite of cardiovascular death, aborted cardiac arrest, nonfatal MI, nonfatal stroke, or hospitalization for the management of heart failure. β, beta-blockers; MI, myocardial infarction.

Figure 2

Primary and secondary outcomes in propensity score-matched patients without a history of MI. Rates of freedom from primary outcome events (A), all-cause death (B), major cardiovascular events (C), and hospitalization for heart failure (D). The primary outcome was a composite of cardiovascular death, aborted cardiac arrest, nonfatal MI, nonfatal stroke, or hospitalization for the management of heart failure. Major cardiovascular events included all-cause death, nonfatal MI, and nonfatal stroke. β, beta-blockers; MI, myocardial infarction.

Figure 3

Cardiovascular and non-cardiovascular death in propensity score-matched patients without a history of MI. Rates of freedom from cardiovascular death (A) and non-cardiovascular death (B). β, beta-blockers; MI, myocardial infarction.