Contemporary Use of β-Blockers in Heart Failure Patients With and Without Atrial Fibrillation: A Nationwide Database Analysis

Contemporary Use of β-Blockers in Heart Failure Patients With and Without Atrial Fibrillation: A Nationwide Database Analysis Clin Pharmacol Ther. 2024 Nov 18. doi: 10.1002/cpt.3496. Abstract Evidence of the effectiveness of β-blockers in heart failure (HF) and atrial fibrillation (AF) in a contemporary cohort is controversial. This study investigated the association between the use of β-blockers and prognosis in hospitalized heart failure patients with and without atrial fibrillation in Japan. Patients hospitalized with the first episode of acute heart failure were identified from the National Database of Health Insurance Claims and Specific Health Checkups of Japan between April 2014 and March 2021. Associations of β-blocker use and prognosis were compared by propensity score matching among the atrial fibrillation or non- atrial fibrillation group. A mixed-effects survival model was used, and hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated. Among 428,650  patients discharged with Heart Failure in 4,433 hospitals, 175,174 (40.9%) were ≥ 85 years old, 151,873 (35.4%) had complicated atrial fibrillation, and 236 ,457 (55.2%) were β-blocker users. In a matched atrial fibrillation group, β-blocker use was associated with a lower composite outcome of all-cause mortality or HF rehospitalization (HR [95% CI], 0.95 [0.93-0.97]). A similar result was obtained in a matched non- atrial fibrillation group (0.95 [0.94-0.96]). In addition, the hazard ratios in patients aged ≥ 85 years and female patients were 1.00 [0.98-1.02] and 1.01 [0.98-1.03] in the atrial fibrillation group and 1.03 [1.01-1.05] and 0.98 [0.97-1.00] in the non- atrial fibrillation group, respectively. The favorable prognostic associations of β-blocker use were observed regardless of atrial fibrillation in patients across a broad spectrum of heart failure in a superaged society.  Disclaimer: Lupin makes no representation or warranty of any kind, expressed or implied, regarding the accuracy, adequacy, validity, reliability, availability, or completeness of any scientific information shared by the HCP on the ­­­STAR UPDATE podcast. You should not allow the contents of this to substitute for your own medical judgment, which you should exercise in evaluating the information on this website.