Beta-blockers for the prevention of sudden cardiac death in heart failure patients: a meta-analysis of randomized controlled trials

Al-Gobari, Muaamar; Khatib, Chadia El; Pillon, François; Gueyffier, François

doi:10.1186/1471-2261-13-52

Cited by 113 publications

(77 citation statements)

References 43 publications

(34 reference statements)

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“…This was consistent with other research that concluded in patients with CHD who underwent noncardiac surgery, beta-blockers can reduce the incidence of death and MACE significantly, especially in patients who have recently experienced a myocardial infarction and patients with heart failure [33]. Beta-blocker therapy in heart failure patients also proven to reduce the risk of sudden death from a cardiovascular event by 31%, 29% cardiovascular death and death from all causes by 33% [34].…”

Section: Discussionsupporting

confidence: 91%

Effectiveness of Ticagrelor Compared to Clopidogrel in Reducing the Risk of Major Adverse Cardiovascular Events in Patients With Coronary Heart Disease After Percutaneous Coronary Intervention

Nur’amin

Dwiprahasto

Kristin

2017

Int J Pharm Pharm Sci

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Objective: Antiplatelet therapy is recommended in patients with coronary heart disease (CHD) who had the percutaneous coronary intervention (PCI) procedure to reduce major adverse cardiovascular events (MACE). There has been a lack of population-based studies that showed the superior effectiveness of ticagrelor over clopidogrel and similar studies have not been conducted in Indonesia yet. The aim of the study was to investigate the effectiveness of ticagrelor compared to clopidogrel in reducing the risk of MACE in patients with CHD after PCI. Methods:A retrospective cohort study with 1-year follow-up was conducted. 361 patients consisted of 111 patients with ticagrelor exposure and 250 patients with clopidogrel exposure. The primary outcome was MACE, defined as a composite of repeat revascularization, myocardial infarction, or all-cause death. The association between antiplatelet exposure and the MACE was analyzed with Cox proportional hazard regression, adjusted for sex, age, comorbid, PCI procedures and concomitant therapy.Results: MACE occurred in 22.7% of the subjects. Clopidogrel had a significantly higher risk of MACE compared with ticagrelor (28.8%, vs 9.0%, hazard ratio (HR): 1.96 (95% CI 1.01 to 3.81, p=0.047). There were no significant differences in risk of repeat revascularization (20.40% vs 5.40%, HR: 2.32, 95% CI 0.99 to 5.42, p = 0.05), myocardial infarction (11.60% vs 3.60%, HR: 2.08, 95% CI, 0.73 to 5.93, p = 0.17), and death (1.60% vs 1.80%, HR: 0.77, 95% CI, 0.14 to 4.25, p = 0.77). Conclusion:Clopidogrel had a higher risk of MACE compared to clopidogrel in patients with CHD after PCI, but there were no significant differences in the risk of repeat revascularization, myocardial infarction, and all-cause death.

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Section: Discussionsupporting

confidence: 91%

Effectiveness of Ticagrelor Compared to Clopidogrel in Reducing the Risk of Major Adverse Cardiovascular Events in Patients With Coronary Heart Disease After Percutaneous Coronary Intervention

Nur’amin

Dwiprahasto

Kristin

2017

Int J Pharm Pharm Sci

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“…Nonetheless, our study corroborates a potential reduction in mortality with CIs from propensity-adjusted analyses suggesting a 20% to 30% reduction in mortality rates, consistently with other reports. [23][24][25][26] This reduction was observed among AF patients both with and without concomitant HF.…”

Section: Discussionmentioning

confidence: 99%

β-Blockers in Atrial Fibrillation Patients With or Without Heart Failure

Nielsen

Larsen

Gorst‐Rasmussen

et al. 2016

Circ: Heart Failure

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Background— Recent data suggest that β-blockers are associated with prognostic advantages in heart failure (HF) patients without concomitant atrial fibrillation (AF), but not in HF patients with concomitant AF. We aimed to investigate associations between β-blocker treatment and cardiovascular outcome and mortality in AF patients with and without HF. Methods and Results— Three nationwide registries were used to identify patients with nonvalvular AF patients with or without concomitant HF. Patients were stratified into β-blocker users and β-blocker nonusers, and according to the presence of a HF diagnosis. We followed the patients ≤5 years after baseline. Six different cardiovascular outcomes were investigated, including all-cause mortality and fatal thromboembolic events. Crude event rates were ascertained and propensity-matched Cox regression was used to compare event rates according to β-blocker usage status. A total of 205 174 patients were included, where 39 741 patients had prevalent HF. In the latter subgroup of patients, the 1-year propensity-matched hazard ratio (HR) for all-cause mortality was 0.75 (95% confidence interval, 0.71–0.79; nontreated used as reference). For patients without concomitant HF, the propensity-matched HR for all-cause mortality was 0.78 (95% confidence interval, 0.71–0.76). Conclusions— In this large nationwide cohort study, evidence of a lower mortality with β-blocker therapy in AF patients with concomitant HF was observed. In addition, this association was accompanied with indications that β-blocker treatment is also associated with a better prognosis in AF patients without concomitant HF.

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“…[2][3][4][5] However, ICDs are costly, have occasional complications early after implantation (e.g., infection), and may have later adverse outcomes including inappropriate shocks and device malfunction that lead, in some patients, to a diminished quality of life. 6 The currently recommended medications for heart failure with reduced ejection fraction, including angiotensin-converting-enzyme (ACE) inhibitors or angiotensin-receptor blockers, 7,8 beta-blockers, 9 and mineralocorticoid-receptor antagonists, 10 reduce the risk of sudden death. After the accrual of evidence from randomized, controlled trials, these drugs have increasingly been used in combination, with the latest guidelines recommending treatment with all three in most patients.…”

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confidence: 99%

Declining Risk of Sudden Death in Heart Failure

et al. 2017

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BACKGROUNDThe risk of sudden death has changed over time among patients with symptomatic heart failure and reduced ejection fraction with the sequential introduction of medications including angiotensin-converting-enzyme inhibitors, angiotensin-receptor blockers, beta-blockers, and mineralocorticoid-receptor antagonists. We sought to examine this trend in detail. METHODSWe analyzed data from 40,195 patients who had heart failure with reduced ejection fraction and were enrolled in any of 12 clinical trials spanning the period from 1995 through 2014. Patients who had an implantable cardioverter-defibrillator at the time of trial enrollment were excluded. Weighted multivariable regression was used to examine trends in rates of sudden death over time. Adjusted hazard ratios for sudden death in each trial group were calculated with the use of Cox regression models. The cumulative incidence rates of sudden death were assessed at different time points after randomization and according to the length of time between the diagnosis of heart failure and randomization. RESULTSSudden death was reported in 3583 patients. Such patients were older and were more often male, with an ischemic cause of heart failure and worse cardiac function, than those in whom sudden death did not occur. There was a 44% decline in the rate of sudden death across the trials (P = 0.03). The cumulative incidence of sudden death at 90 days after randomization was 2.4% in the earliest trial and 1.0% in the most recent trial. The rate of sudden death was not higher among patients with a recent diagnosis of heart failure than among those with a longer-standing diagnosis. CONCLUSIONSRates of sudden death declined substantially over time among ambulatory patients with heart failure with reduced ejection fraction who were enrolled in clinical trials, a finding that is consistent with a cumulative benefit of evidence-based medications on this cause of death. (Funded by the China Scholarship Council and the University of Glasgow.)A BS TR AC T

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Beta-blockers for the prevention of sudden cardiac death in heart failure patients: a meta-analysis of randomized controlled trials

Cited by 113 publications

References 43 publications

Effectiveness of Ticagrelor Compared to Clopidogrel in Reducing the Risk of Major Adverse Cardiovascular Events in Patients With Coronary Heart Disease After Percutaneous Coronary Intervention

Effectiveness of Ticagrelor Compared to Clopidogrel in Reducing the Risk of Major Adverse Cardiovascular Events in Patients With Coronary Heart Disease After Percutaneous Coronary Intervention

β-Blockers in Atrial Fibrillation Patients With or Without Heart Failure

Declining Risk of Sudden Death in Heart Failure

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