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Review
. 2013 Jan 16:346:f55.
doi: 10.1136/bmj.f55.

Benefits of β blockers in patients with heart failure and reduced ejection fraction: network meta-analysis

Saurav Chatterjee  1 , Giuseppe Biondi-Zoccai, Antonio Abbate, Fabrizio D'Ascenzo, Davide Castagno, Benjamin Van Tassell, Debabrata Mukherjee, Edgar Lichstein
Affiliations
Review

Benefits of β blockers in patients with heart failure and reduced ejection fraction: network meta-analysis

Saurav Chatterjee et al. BMJ. .

Erratum in

  • BMJ. 2013;346:f596

Abstract

Objective: To clarify whether any particular β blocker is superior in patients with heart failure and reduced ejection fraction or whether the benefits of these agents are mainly due to a class effect.

Design: Systematic review and network meta-analysis of efficacy of different β blockers in heart failure.

Data sources: CINAHL(1982-2011), Cochrane Collaboration Central Register of Controlled Trials (-2011), Embase (1980-2011), Medline/PubMed (1966-2011), and Web of Science (1965-2011).

Study selection: Randomized trials comparing β blockers with other β blockers or other treatments.

Data extraction: The primary endpoint was all cause death at the longest available follow-up, assessed with odds ratios and Bayesian random effect 95% credible intervals, with independent extraction by observers.

Results: 21 trials were included, focusing on atenolol, bisoprolol, bucindolol, carvedilol, metoprolol, and nebivolol. As expected, in the overall analysis, β blockers provided credible mortality benefits in comparison with placebo or standard treatment after a median of 12 months (odds ratio 0.69, 0.56 to 0.80). However, no obvious differences were found when comparing the different β blockers head to head for the risk of death, sudden cardiac death, death due to pump failure, or drug discontinuation. Accordingly, improvements in left ventricular ejection fraction were also similar irrespective of the individual study drug.

Conclusion: The benefits of β blockers in patients with heart failure with reduced ejection fraction seem to be mainly due to a class effect, as no statistical evidence from current trials supports the superiority of any single agent over the others.

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Conflict of interest statement

Competing interests: All authors have completed the Unified Competing Interest form at http://www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organization for the submitted work; no financial relationships with any organizations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

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Fig 1 Review profile. RCT=randomized controlled trial
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Fig 2 Evidence network
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Fig 3 Standard pair-wise meta-analysis of β blockers and effect on mortality in chronic heart failure
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Fig 4 Trim and fill adjusted odds ratio (calculated by imputing effect of possible missing studies)—shown to be less than 1, indicating robust and conclusive evidence in favor of mortality benefit with β blocker use in heart failure
See this image and copyright information in PMC

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