Differential Impact of Metoprolol Formulations on Heart Failure Outcomes: A Multi-center Study

Differential Impact of Metoprolol Formulations on Heart Failure Outcomes: A Multi-center Studyhttps://doi.org/10.1016/j.yjcafi.2025.10.010 ABSTRACT Background Despite widespread use of metoprolol formulations in heart failure (HF), direct comparative evidence of theirclinical outcomes remains limited. MethodsIn this retrospective cohort study using the TriNetX Research Network (2010-2024), we compared outcomes between metoprolol succinate and tartrate in heart failure withreduced ejection fraction HFrEF (EF ≤40%) and HFmrEF HeartFailure with Mid-range Ejection Fraction (EF 41-49%) patients. After propensity score matching (761 pairs for HFrEF, 732 pairs for HFmrEF), we evaluated a primary composite outcome of hospitalizations and all-cause mortality, and secondary outcomes of individual components over one year follow-up. ResultsBaseline characteristics were well-balanced between cohorts in both HF populations. For the primary composite outcome, both heart failure with reduced ejection fraction and Heart Failure with Mid-range Ejection Fraction patients receiving succinate formulation demonstrated significantly betterevent-free survival compared to tartrate (HFrEF: 64.12% vs 51.22%, log-rank p<0.001; HFmrEF: 67.57% vs 56.04%, log-rank p<0.001). Secondary analysis revealed these benefits were driven by improvements in both hospitalizations andall-cause mortality. ConclusionsMetoprolol succinate was associated with significantly improved event-free survival compared to tartrate in Kaplan-Meier analyses for both heart failure with reduced ejectionfraction and Heart Failure with Mid-range Ejection Fraction populations, despite modest differences in crude event rates. These findings suggest that formulation-specific pharmacokinetics influence long-term outcomes in heartfailure management, supporting current guidelines favoring succinate over tartrate.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 ­­­STARUPDATE 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.