Evidence profileComparison of selective vs non-selective beta blockers

Question: Should Selective BB vs non-selective BB be used for chronic heart failure?

Bibliography: Bibliography: Poole-Wilson PA SK. Comparison of carvedilol and metoprolol on clinical outcomes in patients with chronic heart failure in the Carvedilol Or Metoprolol European Trial (COMET): randomised controlled trial. Lancet. 2003; 362(9377):7–13. Ref ID: 215; Sanderson JE, Chan SK, Yip G et al. Beta-blockade in heart failure: a comparison of carvedilol with metoprolol. Journal of the American College of Cardiology. 1999; 34(5):1522–1528. Ref ID: 942

Quality assessmentSummary of findingsHazard ratio
No of patientsEffectQuality
No of studiesDesignLimitationsInconsistencyIndirectnessImprecisionOther considerationsSelective BBnon-selective BBRelative (95% CI)Absolute
Mortality and hospitalisation - all cause (follow-up mean 58 months)
1 Poole-Wilsonrandomised trialno serious limitationsno serious inconsistencyno serious indirectnessno serious imprecisionNone1160/1518 (76.4%)1116/1511 (73.9%)RR 1.03 (0.99 to 1.08)22 more per 1000 (from 7 fewer to 59 more)⊕⊕⊕⊕
HIGH
Mortality - all cause (follow-up mean 58 months)
1 Poole-Wilsonrandomised trialno serious limitationsno serious inconsistencyno serious indirectnessserious1None600/1518 (39.5%)512/1511 (33.9%)RR 1.17 (1.06 to 1.28)58 more per 1000 (from 20 more to 95 more)⊕⊕⊕○
MODERATE
1.22 (1.08 to 1.37)
0%0 more per 1,000
Sudden death (follow-up mean 58 months)
1 Poole-Wilsonrandomised trialno serious limitationsno serious inconsistencyno serious indirectnessserious1None262/1518 (17.3%)218/1511 (14.4%)RR 1.20 (1.01 to 1.41)29 more per 1000 (from 1 more to 59 more)⊕⊕⊕○
MODERATE
1.35 (1.03 to 1.78)
Quality of Life (follow-up 12 weeks; measured with: Minnesota Living with Heart Failure; range of scores: 0–105; Better indicated by less)
1 Sandersonrandomised trialno serious limitationsno serious inconsistencyno serious indirectnessserious2None2625-MD −3.30 (−4.25 to −2.35)⊕⊕⊕○
MODERATE
Adverse events - no. of patients (follow-up mean 58 months)
1 Poole-Wilsonrandomised trialno serious limitationsno serious inconsistencyno serious indirectnessno serious imprecisionNone1457/1518 (96%)1420/1511 (94%)RR 1.02 (1 to 1.04)19 more per 1000 (from 0 more to 38 more)⊕⊕⊕⊕
HIGH
1

95% confidence interval (or alternative estimate of precision) around the pooled or best estimate of effect includes both negligible effect and appreciable harm.

2

upper or lower confidence limit crosses an effect size of 0.5 in either direction.

From: 5, Treating heart failure

Cover of Chronic Heart Failure
Chronic Heart Failure: National Clinical Guideline for Diagnosis and Management in Primary and Secondary Care: Partial Update [Internet].
NICE Clinical Guidelines, No. 108.
National Clinical Guideline Centre (UK).
Copyright © 2010, National Clinical Guideline Centre.

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