Copyright © 1997 by the European Society of Cardiology.
© 1997 The European Society of Cardiology
Effects of beta-blocker therapy on mortality in patients with heart failure
A systematic overview of randomized controlled trials
Clinical Trials Research Unit, Department of Medicine, Faculty of Medicine and Health Science, The University of Auckland Auckland, New Zealand
Received 4 December 1996; accepted 12 December 1996.
Correspondence: Dr Robert Doughty, Department of Medicine, The University of Auckland, Private Bag 92019, Auckland, New Zealand
Abstract
AIMS: Several randomized trials have reported that beta-blocker therapy improves left ventricular function and reduces the rate of hospitalization in patients with congestive heart failure. However, most trials were individually too small to assess reliably the effects of treatment on mortality. In these circumstances a systematic overview of all trials of beta-blocker therapy in patients with congestive heart failure may provide the most reliable guide to treatment effects.
METHODS AND RESULTS: Details were sought from all completed randomized trials of oral beta-blocker therapy in patients with heart failure of any aetiology. In particular, data on mortality were sought from all randomized patients for the scheduled treatment period. The typical effect of treatment on mortality was estimated from an overview in which the results of all individual trials were combined using standard statistical methods. Twenty-four randomized trials, involving 3141 patients with stable congestive heart failure were identified. Complete data on mortality were obtained from all studies, and a total of 297 deaths were documented during an average of 13 months of follow-up. Overall, there was a 31% reduction in the odds of death among patients assigned a beta-blocker (95% confidence interval 11 to 46%, 2P=0·0035), representing an absolute reduction in mean annual mortality from 9·7% to 7·5%. The effects on mortality of vasodilating beta-blockers (47% reduction SD 15), principally carvedilol, were nonsignificantly greater (2P=0·09) than those of standard agents (18% reduction SD 15), principally metoprolol.
CONCLUSION: Beta-blocker therapy is likely to reduce mortality in patients with heart failure. However, large-scale, long-term randomized trials are still required to confirm and quantify more precisely the benefit suggested by this overview.
Key Words: Meta-analysis • beta-adrenergic antagonists • survival
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