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Meta-analysis: beta-blocker dose, heart rate reduction, and death in patients with heart failure.

Publication ,  Journal Article
McAlister, FA; Wiebe, N; Ezekowitz, JA; Leung, AA; Armstrong, PW
Published in: Ann Intern Med
June 2, 2009

BACKGROUND: Guidelines recommend that patients with heart failure receive beta-blockers in doses used in the trials that have proven their efficacy. Although the adverse effects of beta-blockade are dose-related, it is unclear whether the benefits are. PURPOSE: To determine whether the survival benefits of beta-blockade in heart failure are associated with the magnitude of heart rate reduction or the beta-blocker dose. DATA SOURCES: MEDLINE, EMBASE, CINAHL, SIGLE, Web of Science, and the Cochrane Central Register of Controlled Trials, supplemented by hand-searches of bibliographies. STUDY SELECTION: Randomized, placebo-controlled heart failure trials that reported all-cause mortality. DATA EXTRACTION: Two reviewers independently extracted data on study characteristics, beta-blocker dosing and heart rate reduction, and death. DATA SYNTHESIS: The mean left ventricular ejection fraction in the 23 beta-blocker trials ranged from 0.17 to 0.36, and more than 95% of the 19 209 patients had systolic dysfunction. The overall risk ratio for death was 0.76 (95% CI, 0.68 to 0.84); however, heterogeneity testing revealed moderate heterogeneity among trials (I (2) = 30%), which was associated with the magnitude of heart rate reduction achieved within each trial (P for meta-regression = 0.006). For every heart rate reduction of 5 beats/min with beta-blocker treatment, a commensurate 18% reduction (CI, 6% to 29%) in the risk for death occurred. No significant relationship between all-cause mortality and beta-blocker dosing was observed (risk ratio for death, 0.74 [CI, 0.64 to 0.86]) in high-dose beta-blocker trials vs. 0.78 [CI, 0.63 to 0.96] in low-dose beta-blocker trials; P for meta-regression = 0.69). LIMITATIONS: The analysis is based on aggregate data and resting heart rates. Few patients in these trials had bradycardia or diastolic dysfunction at baseline. CONCLUSION: The magnitude of heart rate reduction is statistically significantly associated with the survival benefit of beta-blockers in heart failure, whereas the dose of beta-blocker is not.

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Published In

Ann Intern Med

DOI

EISSN

1539-3704

Publication Date

June 2, 2009

Volume

150

Issue

11

Start / End Page

784 / 794

Location

United States

Related Subject Headings

  • Randomized Controlled Trials as Topic
  • Humans
  • Heart Rate
  • Heart Failure
  • General & Internal Medicine
  • Cause of Death
  • Adrenergic beta-Antagonists
  • 3202 Clinical sciences
  • 11 Medical and Health Sciences
 

Citation

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McAlister, F. A., Wiebe, N., Ezekowitz, J. A., Leung, A. A., & Armstrong, P. W. (2009). Meta-analysis: beta-blocker dose, heart rate reduction, and death in patients with heart failure. Ann Intern Med, 150(11), 784–794. https://doi.org/10.7326/0003-4819-150-11-200906020-00006
McAlister, Finlay A., Natasha Wiebe, Justin A. Ezekowitz, Alexander A. Leung, and Paul W. Armstrong. “Meta-analysis: beta-blocker dose, heart rate reduction, and death in patients with heart failure.Ann Intern Med 150, no. 11 (June 2, 2009): 784–94. https://doi.org/10.7326/0003-4819-150-11-200906020-00006.
McAlister FA, Wiebe N, Ezekowitz JA, Leung AA, Armstrong PW. Meta-analysis: beta-blocker dose, heart rate reduction, and death in patients with heart failure. Ann Intern Med. 2009 Jun 2;150(11):784–94.
McAlister, Finlay A., et al. “Meta-analysis: beta-blocker dose, heart rate reduction, and death in patients with heart failure.Ann Intern Med, vol. 150, no. 11, June 2009, pp. 784–94. Pubmed, doi:10.7326/0003-4819-150-11-200906020-00006.
McAlister FA, Wiebe N, Ezekowitz JA, Leung AA, Armstrong PW. Meta-analysis: beta-blocker dose, heart rate reduction, and death in patients with heart failure. Ann Intern Med. 2009 Jun 2;150(11):784–794.

Published In

Ann Intern Med

DOI

EISSN

1539-3704

Publication Date

June 2, 2009

Volume

150

Issue

11

Start / End Page

784 / 794

Location

United States

Related Subject Headings

  • Randomized Controlled Trials as Topic
  • Humans
  • Heart Rate
  • Heart Failure
  • General & Internal Medicine
  • Cause of Death
  • Adrenergic beta-Antagonists
  • 3202 Clinical sciences
  • 11 Medical and Health Sciences