Format

Send to

Choose Destination
BMJ. 2013 Jan 16;346:f55. doi: 10.1136/bmj.f55.

Benefits of β blockers in patients with heart failure and reduced ejection fraction: network meta-analysis.

Author information

1
Division of Internal Medicine, Maimonides Medical Center, New York, NY, USA. sauravchatterjeemd@gmail.com

Erratum in

  • BMJ. 2013;346:f596.

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.

PMID:
23325883
PMCID:
PMC3546627
DOI:
10.1136/bmj.f55
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for HighWire Icon for PubMed Central
Loading ...
Support Center