beta-blockers in congestive heart failure - A Bayesian meta-analysis

Purpose: Congestive heart failure is an important cause of patient morbidit y and mortality. Although several randomized clinical trials have compared beta -blockers with placebo for treatment of congestive heart failure, a me ta-analysis quantifying the effect on mortality and morbidity has not been performed recently. Data Sources: The MEDLINE, Cochrane, and Web of Science electronic database s were searched from 1966 to July 2000. References were also identified fro m bibliographies of pertinent articles. Study Selection: All randomized clinical trials of beta -blockers versus pl acebo in chronic stable congestive heart failure were included. Data Extraction: A specified protocol was followed to extract data on patie nt characteristics, beta -blocker used, overall mortality, hospitalizations for congestive heart failure, and study quality. Data Synthesis: A hierarchical random-effects model was used to synthesize the results, A total of 22 trials involving 10 135 patients were identified . There were 624 deaths among 4862 patients randomly assigned to placebo an d 444 deaths among 5273 patients assigned to beta -blocker therapy. In thes e groups, 754 and 540 patients, respectively, required hospitalization for congestive heart failure, The probability that beta -blocker therapy reduce d total mortality and hospitalizations for congestive heart failure was alm ost 100%. The best estimates of these advantages are 3.8 lives saved and 4 fewer hospitalizations per 100 patients treated in the first year after the rapy. The probability that these benefits are clinically significant (>2 li ves saved or >2 fewer hospitalizations per 100 patients treated) is 99%, Bo th selective and nonselective agents produced these salutary effects. The r esults are robust to any reasonable publication bias, Conclusions: beta -Blocker therapy is associated with clinically meaningful reductions in mortality and morbidity in patients with stable congestive h eart failure and should be routinely offered to all patients similar to tho se included in trials.