Abstract
Background
Despite the lack of data supporting their benefits, beta-blockers (BBs) frequently prescribed for heart failure with preserved ejection fraction (HFpEF). This may be due to the other indications (coronary heart disease, atrial fibrillation, etc.) on the one hand and due to clinical inertia with translation evidence from heart failure with reduced ejection fraction to HFpEF on the other.
Purpose
To assess the trends in BBs administration and prevalence of the possible indications for their usage (hypertension, atrial fibrillation, coronary heart disease, myocardial infarction) in the participants of the randomized clinical trials (RCTs) of HFpEF.
Methods
A systematic literature search of PubMed database was performed. RCTs of pharmacological treatment of HFpEF carried out between 1993 and 2019 were used. Studies of the effectiveness of BBs usage, or studies performed in specific populations (HFpEF+coronary heart disease or HFpEF+hypertension, etc.) were excluded. Features at enrolment date and data on the frequency of BBs admission and the prevalence of hypertension, atrial fibrillation, coronary heart disease, and myocardial infarction were extracted. The trends over time of enrolment were analyzed using the Mann-Kendall test.
Results
Of the 718 filtered publications, 14 RCTs met the inclusion and exclusion criteria fully. In the most recent trials, up to 75–80% of patients received BBs. Time trends analysis revealed that between 1993–2019 years the frequency of BBs use among the participants of the RCTs of HFpEF significantly increased (tau=0.51, p=0.014). No such change was observed in the prevalence of coronary heart disease, myocardial infarction, hypertension, and atrial fibrillation (all p>0.05). Prevalence of hypertension and atrial fibrillation showed a tendency toward increasing (tau=0.4, p=0.055 and tau=0.043, p=0.063, respectively) which became statistically significant for atrial fibrilation with the exclusion of the ALDO-DHF study (tau=0.5; p=0.042). The prevalence of myocardial infarction tended to decrease over time (tau=−0.73; p=0.06).
Conclusion
Over the last 20 years, the proportion of patients who used BB at enrolment in RCTs of HFpEF increased significantly. There was no statistically significant increase in the prevalence of the formal indications for their usage such as atrial fibrillation, hypertension, coronary heart disease or myocardial infarction. This fact requires attention since some retrospective studies have revealed that BBs use in HFpEF patients is associated with an increased risk of hospitalizations.
FUNDunding Acknowledgement
Type of funding sources: None.
Gender features of heart failure with preserved ejection fraction in patients with myocardial infarction on the background of hypertension
