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Beta-blockers in heart failure – what is the impact of concurrent atrial fibrillation?            

14 Oct, 14 | by Alistair Lindsay

Beta-blockers form an essential cornerstone of therapy for heart failure with reduced ejection fraction. However, the benefits of beta-blockade for heart failure in patients with concurrent atrial fibrillation are less certain. In this meta-analysis of individual-patient data from 10 randomized control trials comparing beta-blockers to placebo for systolic heart failure, investigators assessed the impact of beta-blockade by the presence of sinus rhythm or atrial fibrillation at baseline. Of the 18,254 patients assessed, 76% were in sinus rhythm and 17% were in atrial fibrillation at baseline. Over 1.5 years of mean follow-up, beta-blocker therapy was associated with a significant mortality benefit in sinus rhythm patients (HR 0.73, 0.67-0.80; p<0.001) but not in patients with atrial fibrillation (HR 0.97, 0.83-1.14; p=0.73). Results did not vary by subgroup of patients with atrial fibrillation or for secondary outcomes which included cardiovascular death, cardiovascular hospital admission, and non-fatal stroke. more…

β-blockers beneficial in some, but not all, ischemic heart disease patients undergoing non-cardiac surgery

8 Jun, 14 | by Alistair Lindsay

Whether β-blockers reduce adverse events among patients with stable ischemic heart disease (IHD) undergoing non-cardiac surgery remains in debate. In this Danish study, the authors retrospectively identified 28,263 IHD patients who underwent non-cardiac surgeries and examined the association between pre-procedural β-blockers use and a major adverse cardiovascular event (MACE) defined as 30-day cardiac death, myocardial infarction (MI) and stroke. The cohort included 7,990 patients (28.3%) with heart failure and 12,601 (44.6%) with a history of MI.  Overall, 1,374 (4.9%) experienced a MACE. The risk for MACE was lower among patients treated with β-blockers in the setting of a history of heart failure (adjusted hazard ratio [HR] 0.78; 95% confidence interval [CI] 0.66-0.91) but not among patients without heart failure (adjusted HR 1.11; 95% CI 0.92-1.13). Among patients without heart failure, use of β-blockers was associated with lower risk of MACE in patients with an MI in the prior 2 years (HR 0.54; 95% CI 0.37-0.78). more…

Beta-blockers lower mortality after non-cardiac surgery

22 May, 13 | by Alistair Lindsay

The use of preoperative beta-blockade to minimise the cardiovascular risks of noncardiac surgery has remained controversial for some time, and recent studies have suggested that preoperative beta-blockade may be now decreasing as a result. The purpose of this study was to determine whether early preoperative exposure to beta-blockers could influence 30-day postoperative outcomes in patients undergoing noncardiac surgery. more…

Benefits of beta-blockade in stable coronary disease may be overestimated

8 Nov, 12 | by Alistair Lindsay

While the benefits of beta-blockade following myocardial infarction (MI) are well known, these benefits have been extrapolated to all patients with coronary artery disease (CAD), and even to high risk patients without coronary artery disease. However, beta-blockers also have a number of side effects and their tolerability is not ideal. Therefore, the objective of this study was to evaluate the differential association of beta-blocker use on long-term cardiovascular outcomes in patients with known prior MI, in patients with CAD without MI, and in patients with only risk factors for CAD. more…

Beta-blockers could increase risk in noncardiac surgery

17 Jan, 09 | by Alistair Lindsay

Many trials have suggested a protective role for beta-blockade in noncardiac surgery, and the current ACC/AHA guidelines recommend their use in high-risk patients.  However, preliminary results from the recent POISE (Perioperative Ischemic Evaluation (POISE) trial showed a higher incidence of total deaths and stroke in patients receiving peri-operative bera-blockade compared with placebo. more…

Beta-blockers: all are equal, but some more than others

17 Jan, 09 | by Alistair Lindsay

Carvedilol, Metoprolol and Bisoprolol have all been shown to improve outcomes in patients with heart failure. These evidence based beta-blockers (EBBB) are in contrast to atenolol, propranolol, and timolol, which have not been directly tested in heart failure. Therefore if a patient on one of these agents develops heart failure, is it neccesary to switch them to an EBBB? more…

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