Highlights of ESC HF 2021 - Which Beta Blocker in HFmrEF?

What is the evidence and which beta-blocker should a patient with HFmrEF receive? Till Copernicus trial ejection fraction were used to define outcome of a trial, but now this clinical parameter is used to group individuals with Heart Failure that will yield different outcome to a given treatment. In 2016, ESC Heart Failure guidelines classified and defined HF with reduced ejection fraction, HF with preserved ejection fraction, and HF with mid-range ejection fraction. Studies like CHARM, I PRESERVE & TOPCAT were disappointment as they showed results with ARNI or RAAS inhibitors close to placebo in patients with HF with preserved ejection fraction, only PRAGON-HF trial with Sacubitril/Valsartan showed a positive response. In post hoc analysis of CHARM study, Candesartan treatment showed effectiveness in HF with reserved and mid-range ejection fraction and not in preserved ejection fraction. If we consider retrospective studies with Beta Blockers, in SENIORS trial among all type of HF patient, individuals with mid-range ejection fraction were also fairly represented, and the outcomes showed less mortality & CV hospitalization in patients with LVEF >35%. When further analysis were made with LVEF in quintiles, it was revealed that those in >40-60% had significant mortality and hospitality benefit compared to other quintiles. A meta-analysis of Beta Blockers in Heart Failure showed significant survival from all-cause mortality & CV mortality in patients with LVEF 40-49% with sinus rhythm. Thus it was concluded that post ESC HF guidelines we have more knowledge of outcomes of HF with mid-range ejection fraction, more retrospective evidence, the best evidence of outcome is with Beta Blockers and with Sacubitril + Valsartan from studies with particular data on mid-range Heart failure. Thus we can treat mid-range HF effectively. 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.