Beta-blocker therapy in advanced heart failure: clinical characteristics and long-term outcomes

Aims. To evaluate the clinical characteristics and long-term outcomes of ad vanced heart failure patients (NYHA Class IIIb-IV) receiving beta-blocker t herapy vs, those patients not receiving beta-blockers at randomization in t he FIRST trial, a randomized, double-blind, placebo-controlled trial of epo prostenol vs, usual care in advanced heart failure. Methods and results: Th e patient population consisted of 471 patients enrolled in FIRST with Class IIIb-IV heart failure, left ventricular ejection fraction (LVEF) of <30%, advanced hemodynamic abnormalities, and standard pharmacologic treatment of ACE-inhibitor, diuretics, and/or digoxin. The study cohort consisted of 44 8 patients not receiving beta-blockers and 23 patients receiving beta-block ers at randomization for the FIRST trial. Patients in the beta-blocker grou p had decreased rates of any clinical event (P = 0.03), worsening heart fai lure (P = 0.001), and death or worsening heart failure (P = 0.0008) than pa tients not receiving beta-blockers. After adjusting for prognostically impo rtant variables, the favorable effect of beta-blockers on worsening heart f ailure (P = 0.02) and death or worsening heart failure (P = 0.02) persisted . Conclusion: Patients with advanced heart failure who receive beta-blocker therapy have a lower rate of hospitalization and are less likely to experi ence worsening heart failure or death at 6 months than patients who are not treated with beta-blockers. These observational data contribute to the gro wing body of data demonstrating a favorable effect of beta-blockers on clin ical outcomes in heart failure. (C) 1999 European Society of Cardiology. Al l rights reserved.