BACKGROUND: The usefulness of β-blockers in heart failure (HF) patients with permanent atrial fibrillation (AF) has been questioned. METHODS AND RESULTS: We analyzed data from HF patients (958 patients (801 males, 84%, age 67 ± 11 years)) with AF enrolled in the MECKI score database. We evaluated prognosis (composite of cardiovascular death, urgent heart transplant, or left ventricular assist device) of patients receiving β-blockers (n = 777, 81%) vs. those not treated with β-blockers (n = 181, 19%). We also analyzed the role β1-selectivity and the role of daily β-blocker dose. To account for different HF severity, Kaplan-Meier survival curves were normalized for relevant confounding factors and for treatment strategies. Dose was available in 629 patients. Median follow-up was 1312 (577-2304) days in the entire population, 1203 (614-2420) and 1325 (569-2300) days in patients not receiving and receiving β-blockers. 224 (23%, 54/1000 events/year), 163 (21%, 79/1000 events/year), and 61 (34%, 49/1000 events/year) events were recorded, respectively. At 10-year patients treated with β-blockers had a better outcome (HR 0.447, p < 0.01) with no effects as regards β1selective drugs (53%) vs. β1-β2 blockers (47%). Survival improved in parallel with β-blocker dose increase (HR 0.296, 0.496, 0.490 for the high, medium, and low dose vs. no β-blockers, p < 0.0001). CONCLUSION: HF patients with AF taking a β-blocker have a better outcome (with a survival improvement in parallel with daily dose but no differences as regards β1 selectivity) but this does not mean that β-blockers improve outcomes in these patients as we cannot control for all the potential confounders associated with β-blocker use.

Dose-dependent efficacy of β-blocker in patients with chronic heart failure and atrial fibrillation / Campodonico, J; Piepoli, M; Clemenza, F; Bonomi, A; Paolillo, S; Salvioni, E; Corrà, U; Binno, S; Veglia, F; Lagioia, R; Sinagra, G; Cattadori, G; Scardovi, Ab; Metra, M; Senni, M; Scrutinio, D; Raimondo, R; Emdin, M; Magrì, D; Parati, G; Re, F; Cicoira, M; Minà, C; Limongelli, G; Correale, M; Frigerio, M; Bussotti, M; Perna, E; Battaia, E; Guazzi, M; Badagliacca, Roberto; Di Lenarda, A; Maggioni, A; Passino, C; Sciomer, Susanna; Pacileo, G; Mapelli, M; Vignati, C; Lombardi, C; Filardi, Pp; Agostoni, P. - In: INTERNATIONAL JOURNAL OF CARDIOLOGY. - ISSN 0167-5273. - 273:(2018), pp. 141-146. [10.1016/j.ijcard.2018.08.012]

Dose-dependent efficacy of β-blocker in patients with chronic heart failure and atrial fibrillation.

Magrì D;BADAGLIACCA, ROBERTO;SCIOMER, Susanna;
2018

Abstract

BACKGROUND: The usefulness of β-blockers in heart failure (HF) patients with permanent atrial fibrillation (AF) has been questioned. METHODS AND RESULTS: We analyzed data from HF patients (958 patients (801 males, 84%, age 67 ± 11 years)) with AF enrolled in the MECKI score database. We evaluated prognosis (composite of cardiovascular death, urgent heart transplant, or left ventricular assist device) of patients receiving β-blockers (n = 777, 81%) vs. those not treated with β-blockers (n = 181, 19%). We also analyzed the role β1-selectivity and the role of daily β-blocker dose. To account for different HF severity, Kaplan-Meier survival curves were normalized for relevant confounding factors and for treatment strategies. Dose was available in 629 patients. Median follow-up was 1312 (577-2304) days in the entire population, 1203 (614-2420) and 1325 (569-2300) days in patients not receiving and receiving β-blockers. 224 (23%, 54/1000 events/year), 163 (21%, 79/1000 events/year), and 61 (34%, 49/1000 events/year) events were recorded, respectively. At 10-year patients treated with β-blockers had a better outcome (HR 0.447, p < 0.01) with no effects as regards β1selective drugs (53%) vs. β1-β2 blockers (47%). Survival improved in parallel with β-blocker dose increase (HR 0.296, 0.496, 0.490 for the high, medium, and low dose vs. no β-blockers, p < 0.0001). CONCLUSION: HF patients with AF taking a β-blocker have a better outcome (with a survival improvement in parallel with daily dose but no differences as regards β1 selectivity) but this does not mean that β-blockers improve outcomes in these patients as we cannot control for all the potential confounders associated with β-blocker use.
2018
heart failure, atrial fibrillation, prognosis, beta-blocker, cardiopulmonary exercise test
01 Pubblicazione su rivista::01a Articolo in rivista
Dose-dependent efficacy of β-blocker in patients with chronic heart failure and atrial fibrillation / Campodonico, J; Piepoli, M; Clemenza, F; Bonomi, A; Paolillo, S; Salvioni, E; Corrà, U; Binno, S; Veglia, F; Lagioia, R; Sinagra, G; Cattadori, G; Scardovi, Ab; Metra, M; Senni, M; Scrutinio, D; Raimondo, R; Emdin, M; Magrì, D; Parati, G; Re, F; Cicoira, M; Minà, C; Limongelli, G; Correale, M; Frigerio, M; Bussotti, M; Perna, E; Battaia, E; Guazzi, M; Badagliacca, Roberto; Di Lenarda, A; Maggioni, A; Passino, C; Sciomer, Susanna; Pacileo, G; Mapelli, M; Vignati, C; Lombardi, C; Filardi, Pp; Agostoni, P. - In: INTERNATIONAL JOURNAL OF CARDIOLOGY. - ISSN 0167-5273. - 273:(2018), pp. 141-146. [10.1016/j.ijcard.2018.08.012]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/1182988
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