Beta Blockers No Help in Heart Failure Patients with Atrial Fibrillation

Heart failure patients are routinely given beta blockers, but the drugs appear to have no positive effect on patients who also have atrial fibrillation, a meta-analysis showed.

In a UK study published online Sept. 4 in The Lancet and reported Sept. 1 at the European Society of Cardiology meeting in Barcelona, Spain, lead researcher Dipak Kotecha, PhD, looked at the outcomes of 18,254 patients.

The information was taken from 10 randomized controlled trials comparing beta blockers to placebo in heart failure.

The team looked at individual patient data to see whether the patients initially presented with sinus rhythm or atrial fibrillation, based on electrocardiograph results at baseline.

Kotecha noted that atrial fibrillation and heart failure often coexist “causing substantial cardiovascular morbidity and mortality.”

Though currently both patients with sinus rhythm related heart failure and those with atrial fibrillation get beta blockers, Kotecha said there were no studies showing whether both groups did better with the drugs.

After reviewing patients’ outcomes, Kotecha and colleagues concluded that while patients with sinus rhythm benefitted from the drug therapy, patients with atrial fibrillation did not.

“Based on our findings, beta blockers should not be used preferentially over other rate-control medications and not regarded as standard therapy to improve prognosis in patients with concomitant heart failure and atrial fibrillation,” he wrote.

Commenting on the study Lars Ryden, MD, PhD, of the Karolinska Institute in Stockholm, Sweden, said the meta-analysis study met “the highest possible standard with a cautious collection of

study material.”

But he said a randomized controlled trial (RCT) would be the definitive study.

“We can probably not expect a RCT on the initiative of pharmaceutical companies selling beta-blockers,” Ryden said in a discussion of the study at the Barcelona meeting.

Until such a study is done “we have to accept strong indications from a well-conducted meta-analysis,” he said.

Kotecha is affiliated with the University of Birmingham Centre for Cardiovascular Sciences in Birmingham, UK.

The study got an administrative support grant from Menarini Farmaceutica Internazionale.