Beta blocker versus ivabradine for cardiovascular outcomes among patients with atrial fibrillation

Postgrad Med J. 2022 Aug 22:pmj-2022-141948. doi: 10.1136/pmj-2022-141948. Online ahead of print.


Purpose: We conducted a retrospective observational study using Taiwanese insurance records to examine the association between beta blocker (BB)/ ivabradine (IVA) and cardiovascular (CV) outcomes in patients with atrial fibrillation (AF).

Methods: A total of 1884 AF subjects were enrolled. The propensity score-matching technique was applied to estimate the effect of IVA by accounting for the covariates. The CV outcomes included hospitalisation/rehospitalisation due to acute myocardial infarction, heart failure (HF), haemorrhagic stroke, ischaemic stroke, CV death and all-cause death. Univariate and multivariate Cox proportional hazards regression models were used to estimate crude and adjusted hazard ratios (HRs) and 95% confidence intervals (CIs).

Results: IVA users were found to have a higher risk of HF requiring admission (adjusted HR=2.01; 95% CI 1.67 to 2.42), and all cause death (adjusted HR=1.47; 95% CI 1.11 to 1.94) after adjusting for age, sex, comorbidities and medications.

Conclusion: Concerning adverse clinical events, IVA might not be appropriate for patients with AF.