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Beta-Blockers Less Effective in Heart Failure with Atrial Fibrillation
By Joe Elia
Patients with heart failure and atrial fibrillation do not benefit as much from beta-blocker therapy as those with sinus rhythm, according to a meta-analysis in the Journal of the American College of Cardiology: Heart Failure.
Researchers analyzed mortality outcomes from four studies including over 8500 patients with heart failure and reduced left-ventricular ejection fraction (<40%). Roughly 20% also had atrial fibrillation. Although those with atrial fibrillation who received beta-blockers had lower mortality risks than those receiving placebo (odds ratio, 0.86), patients with sinus rhythm fared much better (OR, 0.63). In addition, beta-blockers did not reduce hospitalizations for heart failure among patients with atrial fibrillation, whereas they did among those with sinus rhythm.
Editorialists call the study, "hypothesis-generating," and conclude that the results "at a minimum" suggest that treatment for those with heart failure and atrial fibrillation "should be approached differently" from those with sinus rhythm.
JACC: Heart Failure article (Free)
Published in Physician's First Watch February 5, 2013
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