TY - JOUR
T1 - Efficacy of beta blockers in patients with heart failure plus atrial fibrillation: an individual-patient data meta-analysis
AU - Kotecha, Dipak
AU - Holmes, Jane
AU - Krum, Henry
AU - Altman, Douglas G
AU - Manzano, Luis
AU - Cleland, John GF
AU - Lip, Gregory YH
AU - Coats, Andrew Justin Stewart
AU - Andersson, Bert
AU - Kirchhof, Paulus
AU - von Lueder, Thomas G
AU - Wedel, Hans
AU - Rosano, Giuseppe
AU - Shibata, Marcelo
AU - Rigby, Alan
AU - Flather, Marcus
PY - 2014
Y1 - 2014
N2 - Background: Atrial fibrillation and heart failure often coexist, causing substantial cardiovascular morbidity and mortality. ? blockers are indicated in patients with symptomatic heart failure with reduced ejection fraction; however, the efficacy of these drugs in patients with concomitant atrial fibrillation is uncertain. We therefore meta-analysed individual-patient data to assess the efficacy of ? blockers in patients with heart failure and sinus rhythm compared with atrial fibrillation. Methods: We extracted individual-patient data from ten randomised controlled trials of the comparison of ? blockers versus placebo in heart failure. The presence of sinus rhythm or atrial fibrillation was ascertained from the baseline electrocardiograph. The primary outcome was all-cause mortality. Analysis was by intention to treat. Outcome data were meta-analysed with an adjusted Cox proportional hazards regression. The study is registered with Clinicaltrials.gov, number NCT0083244, and PROSPERO, number CRD42014010012. Findings: 18 254 patients were assessed, and of these 13 946 (76 ) had sinus rhythm and 3066 (17 ) had atrial fibrillation at baseline. Crude death rates over a mean follow-up of 1?5 years (SD 1?1) were 16 (2237 of 13 945) in patients with sinus rhythm and 21 (633 of 3064) in patients with atrial fibrillation. ?-blocker therapy led to a significant reduction in all-cause mortality in patients with sinus rhythm (hazard ratio 0?73, 0?67-0?80; p
AB - Background: Atrial fibrillation and heart failure often coexist, causing substantial cardiovascular morbidity and mortality. ? blockers are indicated in patients with symptomatic heart failure with reduced ejection fraction; however, the efficacy of these drugs in patients with concomitant atrial fibrillation is uncertain. We therefore meta-analysed individual-patient data to assess the efficacy of ? blockers in patients with heart failure and sinus rhythm compared with atrial fibrillation. Methods: We extracted individual-patient data from ten randomised controlled trials of the comparison of ? blockers versus placebo in heart failure. The presence of sinus rhythm or atrial fibrillation was ascertained from the baseline electrocardiograph. The primary outcome was all-cause mortality. Analysis was by intention to treat. Outcome data were meta-analysed with an adjusted Cox proportional hazards regression. The study is registered with Clinicaltrials.gov, number NCT0083244, and PROSPERO, number CRD42014010012. Findings: 18 254 patients were assessed, and of these 13 946 (76 ) had sinus rhythm and 3066 (17 ) had atrial fibrillation at baseline. Crude death rates over a mean follow-up of 1?5 years (SD 1?1) were 16 (2237 of 13 945) in patients with sinus rhythm and 21 (633 of 3064) in patients with atrial fibrillation. ?-blocker therapy led to a significant reduction in all-cause mortality in patients with sinus rhythm (hazard ratio 0?73, 0?67-0?80; p
UR - http://www.sciencedirect.com/science/article/pii/S0140673614613738
U2 - 10.1016/S0140-6736(14)61373-8
DO - 10.1016/S0140-6736(14)61373-8
M3 - Article
SN - 0140-6736
VL - 384
SP - 2235
EP - 2243
JO - The Lancet
JF - The Lancet
IS - 9961
ER -