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Review
. 2013 Jul 13:13:52.
doi: 10.1186/1471-2261-13-52.

β-Blockers for the prevention of sudden cardiac death in heart failure patients: a meta-analysis of randomized controlled trials

Muaamar Al-Gobari  1 , Chadia El Khatib, François Pillon, François Gueyffier
Affiliations
Review

β-Blockers for the prevention of sudden cardiac death in heart failure patients: a meta-analysis of randomized controlled trials

Muaamar Al-Gobari et al. BMC Cardiovasc Disord. .

Abstract

Background: In many studies, beta-blockers have been shown to decrease sudden cardiac death (SCD) in heart failure patients; other studies reported mixed results. Recently, several large randomized control trials of beta blockers have been carried out. It became necessary to conduct a systematic review to provide an up-to-date synthesis of available data.

Methods: We conducted a meta-analysis of all randomized controlled trials examining the use of beta-blockers vs. placebo/control for the prevention of SCD in heart failure patients. We identified 30 trials, which randomized 24,779 patients to beta-blocker or placebo/control. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Eligible studies had to be randomized controlled trials and provide information on the incidence of sudden cardiac death in heart failure patients. Additional inclusion criteria included: treatment for >30 days and follow-up≥3 months. Studies of patients<18 years, randomization to beta-blocker vs. an angiotensin converting enzyme (without placebo) and/or beta-blocker in both arms were excluded from the analysis. Pre-specified outcomes of interest included SCD, cardiovascular death (CVD), and all-cause mortality and were analyzed according to intention-to-treat.

Results: We found that beta-blockers are effective in the prevention of SCD [OR 0.69; 95% CI, 0.62-0.77, P<0.00001], cardiovascular death (CVD) [OR 0.71; 95% CI, 0.64-0.79, P<0.00001], and all-cause mortality [OR 0.67; 95% CI, 0.59-0.76, P<0.00001]. Based on the study analysis, 43 patients must be treated with a beta-blocker to prevent one SCD, 26 patients to prevent one CVD and 21 patients to prevent all-cause mortality in one year.

Conclusion: Beta-blockers reduce the risk of sudden cardiac death (SCD) by 31%, cardiovascular death (CVD) by 29% and all-cause mortality by 33%. These results confirm the mortality benefits of these drugs and they should be recommended to all patients similar to those included in the trials.

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Figures

Figure 1
Figure 1
PRISMA flow diagram for the meta-analysis. Study selection process according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
Figure 2
Figure 2
Efficacy of beta blockers compared with control for the (A) Prevention of sudden death. (B) Cardiovascular death, and (C) all-cause mortality in patients with heart failure.
Figure 3
Figure 3
Funnel plot of SE (log odds ratio) by odds ratio to evaluate publication bias for effect of treatment in sudden cardiac death (SCD).
Figure 4
Figure 4
Funnel plot of SE (log odds ratio) by odds ratio to evaluate publication bias for effect of treatment for all-cause mortality.
See this image and copyright information in PMC

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