Beta blockers in heart failure

Beta blockers in heart failure

In the yester years, beta blockers were contraindicated in heart failure. But now we have evidence from multiple randomized controlled trials that beta blocker are useful in heart failure with up to 40% reduction in one year mortality. It is worth remembering that most of the clinical trials enroll younger patients and the standard of care is likely to be better in the rigorous protocol of the clinical trials. All these may not translate into real life scenario. Moreover as the population is aging, most of the heart failure patients are elderly and often excluded from clinical trials. Hence we have to rely on registry data to get an idea of real life scenarios in heart failure management. Moreover, most of the data related to heart failure with systolic dysfunction. Data on heart failure with preserved systolic function is scanty. There is also a general notion that beta blocker are underused in heart failure, especially in the elderly. OPTIMIZE-HF [Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure: J Am Coll Cardiol, 2009; 53:184-192] Registry looked at these aspects. They could collect data on nearly twenty five thousand heart failure patients aged 65 years or more and discharged alive from hospitals. From this about three thousand patients with contraindications or intolerance to beta blockers were excluded. Those with lack of documentation on heart failure, whether there was systolic dysfunction or not, were also excluded. Some other groups were excluded for various reasons. Final analysis included about 3,001 patients with left ventricular systolic dysfunction (ejection fraction <40%) and about 4,153 with preserved systolic function. Time to death and time to first re-hospitalization within one year was evaluated. About 60% of those with systolic dysfunction and was not on beta blockers, were initiated on beta blockers during admission. In those with preserved systolic function, only 39% were discharged on beta blockers. In those with left ventricular systolic dysfunction, those who were newly initiated on beta blockers had a 23% lower hazard rate for mortality. There was no significant effect on the hazard of re-hospitalization in this group. Among those with preserved left ventricular systolic function, beta blockers did not have a significant effect on mortality or re-hospitalization. The study also found that elderly patients with heart failure and preserved systolic function had very high one year mortality rate of 32% and one year re-hospitalization rate of 65%.