Association between ß-Blockers and Outcomes in HFpEF - Current Insights from the SwedeHF Registry

ABSTRACT Background s-blockers have an uncertain effect in heart failure with a preserved ejection fraction of 50% or higher (HFpEF). Methods We included patients with HFpEF from the Swedish Heart Failure Registry (SwedeHF) enrolled from 2011 through 2018. In a 2:1 propensity-score matched analysis (β-blocker use versus no-use), we assessed the primary outcome first HF hospitalization, the co-primary outcome cardiovascular (CV) death, and the secondary outcomes all-cause hospitalization and all-cause death. We performed an intention-to-treat and a per-protocol consistency analysis. Results There were a total of 14,434 patients (median age [IQR], 79 [71-85] years; 51% women), 80% treated with a β-blocker at baseline. Treated patients were younger and had higher rates of atrial fibrillation and coronary artery disease, and higher NTproBNP levels. In the 4412:2206 patient matched cohort, at 5 years, 42% (95%-CI 40-44%) versus 44% (95%-CI 41-47%) had a HF admission and 38% [36-40%] versus 40% [36-42%] died from CV causes. In the intention-to-treat analysis β-blocker use was not associated with HF admissions [HR 0.95 (0.87-1.05, p=0.31] and CV death [HR 0.94 (0.85-1.03), p=0.19]. In the subgroup analyses, men appeared to have a more favorable association between β-blockers and outcomes than did women. There we no associations between β-blocker use and secondary outcomes. Conclusions In patients with HFpEF β-blocker use is common but not associated with changes in HF hospitalization or cardiovascular mortality. In the absence of a strong rational and randomized control trials the case for β-blockers in HFpEF remains inconclusive. Bullet points ● The effect of beta-blockers in HFpEF≥50% is uncertain. ● In a propensity score matched HFpEF analysis in the SwedeHF registry, beta-blockers were not associated with a change in risk for HF admissions or CV deaths. Lay summary The optimal treatment for heart failure with a preserved pump function remains unknown. Despite the lack of scientific studies, beta-blockers are very commonly used. When matching patients with a similar risk profile in a large heart failure registry, the use of beta-blockers for the treatment of heart failure with a preserved pump function was not associated with any changes in heart failure hospital admissions or cardiovascular death.