Systematic review of the impact of beta blockers on mortality and hospitaladmissions in heart failure

Heart failure is a common condition that carries a high burden of mortality and morbidity. Several randomised trials have evaluated the effects of bet a blockers in heart failure. This paper gives a systematic overview of publ ished randomised trials of beta blockers in heart failure using standard me thods. In all, 22 randomised controlled trials were identified with a total of 10 480 patients, and an average of 11 months of treatment. The average age was 61 years and 4% were female. Most studies excluded patients with se vere heart failure. Death rates in patients randomised to receive beta bloc kers compared to controls were 458/5657 (8.0%) and 635/4951 (12.8%) respect ively, odds ratio 0.63, 95% CI 0.55-0.72, P < 0.00001. Similar reductions w ere observed for hospital admissions for worsening heart failure (11.3 vs. 17.1%, respectively, odds ratio 0.63) and for the composite outcome of deat h or heart-failure hospital admission (19.4 vs. 26.9%, respectively, odds r atio 0.66). These results show that beta blockers reduce the risk of mortal ity or the need for heart-failure hospital admission by approximately one t hird. Absolute reductions of 5-6% in event rates were observed over approxi mately 1 year of treatment period. These important benefits should be imple mented as a priority, since treatment with beta blockers is inexpensive and heart failure carries a high risk of death and disability. Further informa tion on the effect of beta blockers in elderly patients and women would be helpful. (C) 2001 European Society of Cardiology. All rights reserved.