BETA-BLOCKER THERAPY FOR CONGESTIVE-HEART-FAILURE - A SYSTEMATIC OVERVIEW AND CRITICAL-APPRAISAL OF THE PUBLISHED TRIALS

OBJECTIVE: To evaluate the effect of beta-blockers on mortality and mo rbidity, and to provide an appraisal of the reliability of the availab le data. DATA SOURCES: MEDLINE search for trials of beta-blockers for congestive heart failure (CHF). STUDY SELECTION: All randomized trials of beta-blockers versus placebo, of greater than one month's duration , in patients with CHF. Eighteen published trials involving 2986 patie nts were selected. DATA EXTRACTION: Independently by two authors. DATA SYNTHESIS: The Yusuf-Peto method for combining data was used. Data we re available on mortality in 2841 patients (95%), on hospitalization f or heart failure in 1514 (51%) and on heart transplantation in 2330 (7 9%). There was a lower rate of death in the active treatment group (13 1 of 1606 [8.2%] versus 155 of 1235 [12.6%]; OR=0.72; 99% CI 0.51 to 1 .00), a lower rate of hospitalization for heart failure (137 of 756 [1 8.1%] versus 218 of 758 [28.7%]; OR=0.54; 99% CI 0.39 to 0.74) and a t rend towards a lower proportion of patients receiving heart transplant ation (15 of 1354 [1.1%] versus 26 of 976 [2.7%]; OR=0.45; 99% CI 0.20 to 1.03). Ventricular function improved; however, there was no effect on exercise duration. Although the effects on mortality were nominall y statistically significant, the use of formal methods of interim moni toring adapted for meta-analyses suggests that substantially more pati ents still need to be studied in large scale trials to provide reliabl e and conclusive evidence. CONCLUSIONS: While the available data on th e use of betablockers in CHF appear to be promising, they are neither complete nor robust. The routine use of beta-blockers in patients with heart failure should await the results of ongoing studies.