Abstract
Objective
To clarify whether any particular β blocker is superior in patients
with heart failure and reduced ejection fraction or whether the benefits
of these agents are mainly due to a class effect.
Design Systematic review and network meta-analysis of efficacy of different β blockers in heart failure.
Data sources
CINAHL(1982-2011), Cochrane Collaboration Central Register of
Controlled Trials (-2011), Embase (1980-2011), Medline/PubMed
(1966-2011), and Web of Science (1965-2011).
Study selection Randomized trials comparing β blockers with other β blockers or other treatments.
Data extraction
The primary endpoint was all cause death at the longest available
follow-up, assessed with odds ratios and Bayesian random effect 95%
credible intervals, with independent extraction by observers.
Results
21 trials were included, focusing on atenolol, bisoprolol, bucindolol,
carvedilol, metoprolol, and nebivolol. As expected, in the overall
analysis, β blockers provided credible mortality benefits in comparison
with placebo or standard treatment after a median of 12 months (odds
ratio 0.69, 0.56 to 0.80). However, no obvious differences were found
when comparing the different β blockers head to head for the risk of
death, sudden cardiac death, death due to pump failure, or drug
discontinuation. Accordingly, improvements in left ventricular ejection
fraction were also similar irrespective of the individual study drug.
Conclusion
The benefits of β blockers in patients with heart failure with reduced
ejection fraction seem to be mainly due to a class effect, as no
statistical evidence from current trials supports the superiority of any
single agent over the others.
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