Korean Circ J.  2019 Mar;49(3):238-248. 10.4070/kcj.2018.0259.

Beta-Blockers in Patients with Heart Failure with Preserved Ejection Fraction: Results from The Korea Acute Heart Failure (KorAHF) Registry

• Kim SH
• Yun SC
• Park JJ
• Lee SE
• Jeon ES
• Kim JJ
• Cho MC
• Chae SC
• Kang SM
• Choi DJ
• Yoo BS
• Kim KH
• Oh BH
• Baek SH
• on behalf of KorAHF investigator

• KMID: 2438534
• DOI: http://doi.org/10.4070/kcj.2018.0259

Abstract

BACKGROUND AND OBJECTIVES
Beta-blockers are indicated in patients with heart failure (HF) with reduced ejection fraction. However, their efficacy in patients with HF with preserved ejection fraction (HFpEF) is uncertain. We investigated the hypothesis that beta-blockers are associated with reduced adverse events in patients with HFpEF.
METHODS
The Korea Acute Heart Failure (KorAHF) is a prospective observational multicentre cohort study. The 5,625 patients hospitalized for acute HF syndrome in 10 tertiary university hospitals across the country have been consecutively enrolled between March 2011 and February 2014. Of these patients, 2,152 patients with HFpEF (ejection fraction ≥40%) were investigated. The primary outcome was all-cause mortality according to beta-blocker use.
RESULTS
During a median follow-up duration of 807 days, 702 patients died. In Cox proportional hazards model beta-blocker use was associated with a 14% reduced all-cause death (hazard ratio [HR], 0.86; 95% confidence interval [CI], 0.75-0.98), but not with reduce rehospitalization (HR, 1.03; 95% CI, 0.85-1.27). In the propensity-score matched population, beta-blockers were also associated with reduced all-cause death (HR, 0.80; 95% CI, 0.69-0.94) but not with reduced rehospitalization (HR, 1.08; 95% CI, 0.87-1.33).
CONCLUSIONS
In Korean patients with HFpEF, use of beta-blockers is associated with reduced all-cause death but not with reduced rehospitalization.

Keyword

Adrenergic beta-antagonist; Heart failure; Diastole

MeSH Terms

Cohort Studies
Diastole
Follow-Up Studies
Heart Failure*
Heart*
Hospitals, University
Humans
Korea*
Mortality
Proportional Hazards Models
Prospective Studies

Figure

• 

  Figure 1 Kaplan-Meier curves for all-cause death in the matched cohorts among patients with heart failure with preserved ejection fraction.

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  Figure 2 Interactions and HRs for all-cause death in the matched cohorts among patients with heart failure with preserved ejection fraction.ACEI = angiotensin converting enzyme inhibitor; AF = atrial fibrillation; ARB = angiotensin receptor blocker; BMI = body mass index; CI = confidence interval; CKD = chronic kidney disease; COPD = chronic obstructive pulmonary disease; DM = diabetes mellitus; EF = ejection fraction; HR = hazard ratio; HT = hypertension; IHD = ischemic heart disease; NYHA = New York Heart Association.

• 

  Figure 3 Pattern of beta-blocker prescriptions.

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