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HEART FAILURE: Beta blockade decreases mortality

Clinical Bottom Line

Beta blockade decreases all-cause mortality in patients with CHF.

Clinical Question: In a 70 yr. old man with CAD and CHF, does treatment with a beta-blocker decrease mortality?

Search terms: congestive heart failure, beta antagonists in MEDLINE

The Study

systematic review of 17 randomised controlled trials-study duration >3 months, pts with history of CHF, beta-blocker without ISA used, intention to treat analysis with no crossover

 

The Evidence

Outcome

OR (95% CI)

NNT (95% CI)

Total mortality (at 9 months)

.69 (.54-.88)

35 (22 to94)

Cardiac Mortality

carvedilol

other beta-blockers

.68 (.53-.89)

.44 (.28-.69)

.79 (.56-1.1)

33 (21 to82)

 

 

Comments

  1. did not assess quality of studies
  2. did not weight studies by quality
  3. long term follow up not known (i.e. greater than 1 yr.)
  4. deaths during open label periods of carvedilol not included in the mortality stats of the trials, authors used these in this review to calculate OR of .75 (.59-.96), NNT 41 (23-179)

 

Citation

Heidenreich PA et al. Effect of beta-blockade on mortality in patients with heart failure: A meta-analysis of randomised clinical trials. J Am Coll Cardiol 1997;30:27-34.

 

 

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