Systematic review of the impact of beta blockers on mortality and hospital admissions in heart failure


Shibata, MC; Flather, MD; Wang, DL; (2001) Systematic review of the impact of beta blockers on mortality and hospital admissions in heart failure. European journal of heart failure, 3 (3). pp. 351-7. ISSN 1388-9842

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Abstract

Heart failure is a common condition that carries a high burden of mortality and morbidity. Several randomised trials have evaluated the effects of beta blockers in heart failure. This paper gives a systematic overview of published randomised trials of beta blockers in heart failure using standard methods. In all, 22 randomised controlled trials were identified with a total of 10480 patients, and an average of 11 months of treatment. The average age was 61 years and 4% were female. Most studies excluded patients with severe heart failure. Death rates in patients randomised to receive beta blockers compared to controls were 458/5657 (8.0%) and 635/4951 (12.8%) respectively, odds ratio 0.63, 95% CI 0.55-0.72, P<0.00001. Similar reductions were observed for hospital admissions for worsening heart failure (11.3 vs. 17.1%, respectively, odds ratio 0.63) and for the composite outcome of death or heart-failure hospital admission (19.4 vs. 26.9%, respectively, odds ratio 0.66). These results show that beta blockers reduce the risk of mortality or the need for heart-failure hospital admission by approximately one third. Absolute reductions of 5-6% in event rates were observed over approximately 1 year of treatment period. These important benefits should be implemented as a priority, since treatment with beta blockers is inexpensive and heart failure carries a high risk of death and disability. Further information on the effect of beta blockers in elderly patients and women would be helpful.

Item Type: Article
Keywords: beta blocker, heart failure, meta-analysis, randomised, controlled trial, systematic review, Idiopathic dilated cardiomyopathy, left-ventricular, dysfunction, double-blind, adrenergic-blockade, randomized, trials, clinical-trials, carvedilol, metoprolol, term, metaanalysis, Adrenergic beta-Antagonists, therapeutic use, Adult, Aged, Comparative Study, Confidence Intervals, Double-Blind Method, Endpoint Determination, Female, Follow-Up Studies, Heart Failure, Congestive, drug therapy, etiology, mortality, Human, Male, Middle Age, Odds Ratio, Patient Admission, Survival Analysis, Treatment Outcome
Faculty and Department: Faculty of Epidemiology and Population Health > Dept of Medical Statistics
PubMed ID: 11378007
Web of Science ID: 169189700012
URI: http://researchonline.lshtm.ac.uk/id/eprint/17374

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