Beta-blocker use is not associated with better or worse baseline health status in patients with heart failure with preserved ejection fraction

1. In patients with heart failure with preserved ejection fraction (HFpEF), Beta-blocker use was not associated with concurrent baseline health status or modification of the health status benefit achieved with spironolactone use at 4 months. 

Evidence Rating Level: 2 (Good)

Beta-blockers have traditionally been used in the management of HFpEF, yet recent studies have suggested that the use of β-blockers in this patient population may be associated with adverse outcomes such as increased risk of heart failure hospitalization. However, the association between β-blockers and patient health status, including symptoms and quality of life, is not well known. This cohort study therefore sought to investigate the association between β-blockers and heart failure-related health status among patients with HFpEF. 1726 patients (mean[SD] age, 71.6[9.7] years; 50.1% male) from the multinational TOPCAT randomized clinical trial were included in this study. Health status was assessed using the Kansas City Cardiomyopathy Questionnaire overall summary score (KCCQ-OS) including various dimensions such as symptoms, quality of life and physical and social functioning. β-blockers at baseline were not significantly associated with concurrent KCCQ-OS (mean difference, −1.1 points [95% CI, −3.7 to 1.4 points]; P = .38), and was not significantly associated with KCCQ-OS at 4 months (mean difference, −2.0 points [95% CI, −4.8 to 0.8 points]; P = .16). Patients receiving spironolactone who were also receiving concurrent β-blockers experienced greater health status improvement compared to those not taking concurrent β-blockers, yet the difference was not statistically significant (P = .20 for interaction). Overall, this study found that the use of β-blockers in the management of HFpEF was not associated with a better or worse baseline health status, nor was it associated with any modification of the health status benefit achieved with the use of spironolactone after 4 months. 

Click to read the study in JAMA Network Open

Image: PD

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