Decreased Mortality With Beta-Blockers in Patients With Heart Failure and Coexisting Atrial Fibrillation: An AF-CHF Substudy

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• 作者：Julia Cadrin-Tourigny ; MD^a ; Azadeh Shohoudi ; PhD^b ; Denis Roy ; MD^a ; Mario Talajic ; MD^a ; Rafik Tadros ; MD ; PhD^a ; Blandine Mondé ; sert ; MD^a ; Katia Dyrda ; MD^a ; Lé ; na Rivard ; MD^a ; Jason G. Andrade ; MD^a ; Laurent Macle ; MD^a ; Peter G. Guerra ; MD^a ; Bernard Thibault ; MD^a ; Marc Dubuc ; MD^a ; Paul Khairy ; MD ; PhD^a ; ^b ; ^{paul.khairy@umontreal.ca}
• 关键词：atrial fibrillation ; beta-blockers ; heart failure ; mortality
• 刊名：JACC: Heart Failure
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：5
• 期：2
• 页码：99-106
• 全文大小：863 K
• 卷排序：5

文摘

The impact of beta-blockers on mortality and hospitalizations was assessed in the largest randomized trial of patients with both atrial fibrillation (AF) and heart failure with a reduced ejection fraction (HFrEF): the Atrial Fibrillation-Congestive Heart Failure trial.BackgroundAlthough beta-blockers are the cornerstone of therapy for HFrEF, a recent patient-level meta-analysis cast doubt on their efficacy in patients with coexisting AF.MethodsFrom a total of 1,376 subjects randomized in the AF-CHF trial, those without beta-blockers at baseline were propensity matched to a maximum of 2 exposed patients. All absolute standardized differences after matching were ≤10%. Primary analyses respected the intention-to-treat principle. In on-treatment sensitivity analyses, beta-blocker status was modeled as a time-dependent covariate.ResultsBaseline characteristics were comparable among the matched cohorts (mean age 70 ± 11 years, 81% male, and mean left ventricular ejection fraction 27 ± 6%). During a median follow-up of 37 months, beta-blockers were associated with significantly lower all-cause mortality (hazard ratio [HR]: 0.721, 95% confidence interval [CI]: 0.549 to 0.945; p = 0.0180) but not hospitalizations (HR: 0.886; 95% CI: 0.715 to 1.100; p = 0.2232). Similar results were obtained in sensitivity analyses that modeled beta-blockers as a time-dependent variable (HR: 0.668 for all-cause mortality; 95% CI: 0.511 to 0.874; p = 0.0032; HR: 0.814 for hospitalizations; 95% CI: 0.653 to 1.014; p = 0.0658). There were no significant interactions between beta-blockers and patterns (i.e., persistent vs. paroxysmal) or burden of AF with respect to mortality or hospitalizations.ConclusionsIn propensity-matched analyses, beta-blockers were associated with significantly lower mortality but not hospitalizations in patients with HFrEF and AF, irrespective of the pattern or burden of AF. These results support current evidence-based recommendations for beta-blockers in patients with HFrEF, whether or not they have associated AF.