A systematic review and network meta-analysis 1 of efficacy of different beta-blockers in heart failure included 21 studies with a total of 23 122 subjects treated with atenolol, bisoprolol, bucindolol, carvedilol, metoprolol, nebivolol, or placebo/standard treatment. Patients had a median age of 61 years, 77% were male, ischemic heart failure was present in 57%, baseline LVEF was 25%, and patients were followed for a median of 12 months. Overall pair-wise meta-analysis showed that beta-blockers reduced mortality compared to control (both active and placebo) (OR 0.71, 95% credible interval 0.64 to 0.80). No differences were found between different beta-blockers in the risk of death, sudden cardiac death, death due to pump failure, or drug discontinuation. Improvements in left ventricular ejection fraction were also similar irrespective of the individual study drug.
A systematic rerview 2 included 22 RCTs with a total of 10 480 subjects. The average age was 61.6 years, average EF 26%, and 4% were female. Most studies excluded patients with severe heart failure. Beta-blockers reduced mortality compared to control (OR 0.65, 95% CI 0.57 to 0.74), and hospital admissions for worsening heart failure (OR 0.63, 95% CI 0.56 to 0.71) by approximately one third. Absolute reductions of 5-6% in event rates were observed over approximately 1 year of treatment period.
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