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Beta-Blockers Improve Survival and Decrease Hospitalizations in Patients with Heart Failure
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What is the problem and what is known about it so far?
Congestive heart failure is a condition in which the heart muscle cannot pump blood normally, leading to such symptoms as shortness of breath and fluid accumulation. Heart failure is a common and serious illness in the United States, particularly in older adults. Although many medicines improve symptoms and survival in heart failure, patients with this condition often do not do well, and better treatments are needed. β-Blockers are drugs that slow the heart rate, lower blood pressure, decrease the strength of heart muscle contraction, and prevent abnormal heart rhythms. Some studies have suggested that β-blockers may help patients with heart failure, but the likelihood that they are helpful is unclear.
Why did the researchers do this particular study?
To find out whether β-blockers decrease hospitalization and improve survival in adults with heart failure.
Who was studied?
The researchers studied 10,136 patients with heart failure who had participated in previous studies of the use of β-blockers in heart failure. Patients mostly had mild or moderately severe heart failure; most were already receiving three other drugs for heart failure (digitalis, diuretics, and angiotensin-converting enzyme inhibitors).
How was the study done?
Rather than doing a new study, the researchers analyzed information from 22 previous studies that had assigned patients with heart failure to receive β-blockers or placebo. Placebos were tablets that looked like β-blockers but contained no active ingredient. Individual studies compared two types of β-blockers to placebo; one type has specific effects on the heart (cardioselective agents), and one affects other organs as well as the heart (nonselective agents). Certain other types of β-blockers were avoided because they may actually increase mortality.
What did the researchers find?
Compared with patients taking placebo, patients taking β-blockers were hospitalized less often and died less often of heart failure. The authors estimated that β-blockers saved 3.8 lives and prevented 4 hospitalizations for every 100 patients who were treated for 5 years.
What were the limitations of the study?
The patients in these studies were specially selected. Moreover, many study patients received test doses of β-blockers and did not participate further if they had adverse effects with test doses. Doses of β-blockers were increased very slowly, and patients were followed very closely. The adverse effects of β-blockers may be more common in everyday life than they were in these carefully controlled studies.
What are the implications of the study?
β-Blockers reduce hospitalizations and deaths in patients who are already receiving other therapies for heart failure. These drugs must be given carefully and advanced slowly to moderately high doses.
Article and Author Information
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The summary below is from the full report titled “β-Blockers in Congestive Heart Failure. A Bayesian Meta-Analysis.” It is in the 3 April 2001 issue of Annals of Internal Medicine (volume 134, pages 550-560). The authors are JM Brophy, L Joseph, and JL Rouleau.
- Copyright ©2004 by the American College of Physicians
