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SHR Neuro Cancer Cardio Lipid Metab Microb

Peikert, A; Bart, BA; Vaduganathan, M; Claggett, BL; Kulac, IJ; Kosiborod, MN; Desai, AS; Jhund, PS; Lam, CSP; Inzucchi, SE; Martinez, FA; de, Boer, RA; Hernandez, AF; Shah, SJ; Petersson, M; Langkilde, AM; McMurray, JJV; Solomon, SD; Vardeny, O.
Contemporary Use and Implications of Beta-Blockers in Patients With HFmrEF or HFpEF: The DELIVER Trial.
JACC Heart Fail. 2024; 12(4): 631-644. Doi: 10.1016/j.jchf.2023.09.007
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Leading authors Med Uni Graz: Peikert Alexander
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Abstract:: BACKGROUND: Although beta-blockers are not recommended for the treatment of heart failure with preserved ejection fraction (HFpEF) according to the latest European Society of Cardiology and American Heart Association/American College of Cardiology/Heart Failure Society of America guidelines, these therapies remain commonly used for comorbidity management. There has been concern that beta-blockers may adversely influence clinical outcomes by limiting chronotropic response in HFpEF. OBJECTIVES: This study sought to examine the contemporary use and implications of beta-blockers in patients with heart failure with mildly reduced ejection fraction (HFmrEF) or HFpEF. METHODS: In the DELIVER (Dapagliflozin Evaluation to Improve the Lives of Patients With Preserved Ejection Fraction Heart Failure) trial, a total of 6,263 patients with symptomatic heart failure (HF) with a left ventricular ejection fraction (LVEF) >40% were randomized to dapagliflozin or placebo across 20 countries. In this prespecified analysis, efficacy and safety outcomes were examined according to beta-blocker use at randomization. The primary outcome was cardiovascular death or worsening HF. RESULTS: Overall, beta-blockers were used in 5,177 patients (83%), with wide variation by geographic region. Beta-blocker use was associated with a lower risk of the primary outcome in covariate-adjusted models (HR: 0.70; 95% CI: 0.60-0.83). Dapagliflozin consistently reduced the risk of the primary outcome in patients taking beta-blockers (HR: 0.82; 95% CI: 0.72-0.94) and in patients not taking beta-blockers (HR: 0.79; 95% CI: 0.61-1.03; P_interaction = 0.85), with similar findings for key secondary endpoints. Adverse events were balanced between patients randomized to dapagliflozin and placebo, regardless of background beta-blocker use. CONCLUSIONS: In patients with HFmrEF or HFpEF who were enrolled in DELIVER, 4 out of 5 participants were treated with a beta-blocker. Beta-blocker use was not associated with a higher risk of worsening HF or cardiovascular death. Dapagliflozin consistently and safely reduced clinical events, irrespective of background beta-blocker use. (Dapagliflozin Evaluation to Improve the Lives of Patients With Preserved Ejection Fraction Heart Failure [DELIVER]; NCT03619213).
Find related publications in this database (using NLM MeSH Indexing): Humans - administration & dosage; Heart Failure - administration & dosage; Stroke Volume - physiology; Ventricular Function, Left - physiology; Ventricular Dysfunction, Left - administration & dosage; Benzhydryl Compounds - administration & dosage; Glucosides - administration & dosage
Find related publications in this database (Keywords): beta-blockers; heart failure with mildly reduced ejection fraction; heart failure with preserved ejection fraction; SGLT2 inhibitors