Beta-blockers for heart failure

Safi, Sanam; Korang, Steven Kwasi; Sethi, Naqash J; Feinberg, Joshua; Gluud, Christian; Jakobsen, Janus Christian

doi:10.1002/14651858.cd012897

Cited by 3 publications

(1 citation statement)

References 133 publications

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“…β-blockers have a well-established symptomatic and prognostic benefit in patients with HFrEF. 12 They represent one of the four pillars of HF management which also include angiotensin receptor-neprilysin inhibitors (ARNIs), mineralocorticoid receptor antagonists (MRAs) and sodiumglucose co-transporter 2 inhibitors (SGLT2is). 8 The beneficial effects of β-blockade in HF are mediated by attenuating the damaging effects of sympathetic activation on cardiac muscle.…”

Section: β-Blockadementioning

confidence: 99%

Management of Heart Failure in Patients with Chronic Kidney Disease

2022

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Chronic kidney disease (CKD) is increasingly prevalent in patients with heart failure (HF) and HF is one of the leading causes of hospitalisation, morbidity and mortality in patients with impaired renal function. Currently, there is strong evidence to support the symptomatic and prognostic benefits of β-blockers, renin–angiotensin–aldosterone inhibitors (RAASis), angiotensin receptor-neprilysin inhibitors (ARNIs) and mineralocorticoid receptor antagonists (MRA) in patients with HF and CKD stages 1–3. However, ARNIs, RAASis and MRAs are often suboptimally prescribed for patients with CKD owing to concerns about hyperkalaemia and worsening renal function. There is growing evidence for the use of sodium–glucose co-transporter 2 inhibitors and IV iron therapy in the management of HF in patients with CKD. However, few studies have included patients with CKD stages 4–5 and patients receiving dialysis, limiting the assessment of the safety and efficacy of these therapies in advanced CKD. Interdisciplinary input from HF and renal specialists is required to provide integrated care for the growing number of patients with HF and CKD.

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Section: β-Blockadementioning

confidence: 99%

Management of Heart Failure in Patients with Chronic Kidney Disease

2022

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Dapagliflozin for Heart Failure with Preserved Ejection Fraction: Will the DELIVER Study Deliver?

Williams

Evans

2020

Diabetes Ther

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Drug therapies for people with heart failure and preserved ejection fraction (HFpEF) are often limited to diuretics to improve symptoms as no therapies demonstrate a mortality benefit in this cohort. People with diabetes have a high risk of developing HFpEF and vice versa, suggesting shared pathophysiological mechanisms exist, which in turn engenders the potential for shared treatments. Dapagliflozin is a sodium-glucose co-transporter 2 (SGLT2) inhibitor which has demonstrated significantly improved cardiovascular and hospitalisation for heart failure (HHF) outcomes in previous cardiovascular outcome trials (CVOTs). These CVOTs include the DECLARE-TIMI and DAPA-HF studies which observed significant benefits for people with heart failure and specifically those with heart failure and reduced ejection fraction (HFrEF), respectively. The ongoing DELIVER study is evaluating the use of dapagliflozin specifically in people with HFpEF, which may have enormous implications for treatment and considerable economic consequences. This will complement previous and other ongoing CVOTs evaluating dapagliflozin use. In this review we discuss the use of SGLT2 inhibitors in HFrEF and HFpEF with a focus on the DELIVER study and its potential health and economic implications.

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Pre-Admission Beta-Blocker Therapy and Outcomes of Coronavirus Disease 2019 (COVID-19): A Systematic Review, Meta-Analysis, and Meta-Regression

Hariyanto

Hananto

Intan

et al. 2022

CHDDT

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Background: Hypertension and heart failure are known risk factors for coronavirus disease 2019 (COVID-19) severity and mortality outcomes. Beta-blocker is one of the drugs of choice to treat these conditions. The purpose of this study is to explore the relationship between pre-admission beta-blocker use and COVID-19 outcomes. Methods: PubMed and Europe PMC were used as the database for our search strategy by using combined keywords related to our aims until December 10th, 2020. All articles related to COVID-19 and beta-blocker were retrieved. Review Manager 5.4 and Comprehensive Meta-Analysis 3 software were used to perform statistical analysis. Results: A total of 43 studies consisting of 11,388,556 patients were included in our analysis. Our meta-analysis showed that the use of beta-blocker was associated with increased risk of COVID-19 [OR 1.32 (95% CI 1.02 – 1.70), p = 0.03, I2 = 99%, random-effect modelling], clinical progression [OR 1.37 (95% CI 1.01 – 1.88), p = 0.04, I2 = 89%, random-effect modelling], and mortality from COVID-19 [OR 1.64 (95% CI 1.22 – 2.19), p = 0.0009, I2 = 94%, random-effect modelling]. Meta-regression showed that the association with mortality outcome were influenced by age (p = 0.018) and hypertension (p = 0.005). Conclusions: The risk and benefits of using beta-blocker as a drug of choice to treat hypertensive patients should be put into account and reviewed individually case by case, knowing their association in higher incidence and severity of Covid-19 infections. Other first-line antihypertensive drugs may be considered as an alternative therapy if the risk of administering beta blockers outweigh the benefits in Covid-19 infection.

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Beta-blockers for heart failure

Cited by 3 publications

References 133 publications

Management of Heart Failure in Patients with Chronic Kidney Disease

Management of Heart Failure in Patients with Chronic Kidney Disease

Dapagliflozin for Heart Failure with Preserved Ejection Fraction: Will the DELIVER Study Deliver?

Pre-Admission Beta-Blocker Therapy and Outcomes of Coronavirus Disease 2019 (COVID-19): A Systematic Review, Meta-Analysis, and Meta-Regression

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