The evidence for beta  blockers in heart failure

Cleland, John G.F.; McGowan, James; Clark, Andrew L.; Freemantle, Nick

doi:10.1136/bmj.318.7187.824

Cited by 92 publications

(46 citation statements)

References 10 publications

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“…However, all-cause mortality is a robust outcome even in an unblinded trial. The observed effect was large, additional to that of a high standard of pharmacological therapy and the incremental effect was as large as that of h-blockers compared to placebo in a similar population [18].…”

Section: Discussionmentioning

confidence: 87%

Cardiac resynchronisation for patients with heart failure due to left ventricular systolic dysfunction — a systematic review and meta‐analysis

Freemantle

Tharmanathan

Calvert

et al. 2006

European J of Heart Fail

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175

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Background: Randomised controlled trials generally suggest that cardiac resynchronisation improves outcomes in patients with heart failure due to left ventricular systolic dysfunction and cardiac dyssynchrony. Our objective was to provide a valid synthesis of the effects of CRT on mortality, major morbidity, quality of life and implantation success rates. Methods: Systematic overview and meta-analysis of randomised trials, both blinded and open, comparing cardiac resynchronisation with control. The primary outcome was all-cause mortality, and secondary outcomes included hospitalisation for worsening heart failure, quality of life and implantation success rates. Results: We identified 8 randomised trials which included 3380 patients and observed a total of 524 deaths. Follow-up ranged from 1 month to a mean of 29.4 months. Most trials were of high quality, with centrally administered randomisation and few patients lost to follow-up. CRT reduced mortality in these trials (odds ratio 0.72, 95% CI 0.59 to 0.88). In addition CRT reduced hospitalisation for worsening heart failure (odds ratio 0.55, 95% CI 0.44 to 0.68) and improved quality of life as measured by the Minnesota Living with Heart Failure Questionnaire (weighted mean difference À7.1, 95% CI À 2.9 to À 11.4). Implantation success rates in the trials were 87% or greater. Conclusion: Cardiac resynchronisation in patients with heart failure characterised by dyssynchrony substantially reduces all-cause mortality, major morbidity and improves quality of life.

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Section: Discussionmentioning

confidence: 87%

Cardiac resynchronisation for patients with heart failure due to left ventricular systolic dysfunction — a systematic review and meta‐analysis

Freemantle

Tharmanathan

Calvert

et al. 2006

European J of Heart Fail

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175

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“…Another reason for the underutilizaton of beta-blockers in diabetics could be the higher incidence of heart failure and the fear of worsening their heart failure condition. Chadda et al [26] and others [22,27,28] have reported that patients can benefit from betablockers regardless of their ejection fraction. Many studies have shown that the use of betablockers after MI reduces mortality rate [23,27,29].…”

Section: Discussionmentioning

confidence: 99%

Secondary Prevention Measures after Acute Myocardial Infarction: Comparison between Diabetics and Non-Diabetics at a Saudi Teaching Hospital

Akbar¹

2000

Med Princ Pract

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Objective: To compare between the use of secondary prevention measures after acute myocardial infarction in diabetic and non-diabetic patients who were admitted to the King Abdulaziz University Hospital. Method: All patients admitted with a definitive diagnosis of acute myocardial infarction between January 1995 and December 1999 were studied. Patients’ age, sex, body mass index, development of heart failure, peak serum creatinine phosphokinase, duration of hospital stay, use of aspirin, beta-blockers or angiotensin-converting enzyme (ACE) inhibitors on discharge and outcome were reported. Results: A total of 184 patients were studied, 53% were diabetics and 47% non-diabetics. The mean age for diabetics was 56 years with a male:female ratio of 3.9:1, while for non-diabetics it was 53 years with a male:female ratio of 7.7:1 (p = 0.05, p = 0.09, respectively). Diabetic patients had a higher incidence of heart failure compared to non-diabetics, 57 versus 43% (p = 0.05), and had a longer hospital stay, 12 versus 10 days (p = 0.03). Aspirin was used by 97% of the diabetics and 94% of the non-diabetics (p = 0.4), while beta-blockers were used by 43 and 44% (p = 0.9) and ACE inhibitors by 67 and 51% (p = 0.03), respectively. Conclusion: There is no difference in the use of aspirin and beta-blockers between diabetic and non-diabetic patients. ACE inhibitors were used more by diabetics. There is underutilization of beta-blockers by diabetics and non-diabetics. Physicians should be encouraged to use beta-blockers as secondary prevention measures after acute myocardial infarction as they have substantial benefits and are of generally low treatment cost.

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“…For example, treatments for moderateto-severe heart failure have advanced dramatically over the past 20 years, including the development of a sound evidence base for angiotensin-converting enzyme (ACE) inhibitors, and beta-blockers. Estimates of the absolute benefits of ACE inhibitors taken from randomised trials suggest that all-cause mortality is reduced by around 1.5% per year as a result of their use [5]. Further trials suggest an additional absolute benefit of around 3.5% in reducing mortality from the use of beta-blockers [5].…”

Section: Introduction2the Basis For Appraisalmentioning

confidence: 98%

Biostatistical aspects for the use of evidence based medicine in health technology assessment

Freemantle

2008

Eur J Health Econ

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Health systems throughout the world are increasingly concerned with the evaluation of the effectiveness and cost-effectiveness of pharmaceuticals (and health technologies more generally), in order to enhance the extent to which scarce health resources are used efficiently. Regulatory processes designed to demonstrate efficacy, quality and safety are added to the concept of efficiency or value for money. These regulatory processes serve to identify and ensure that a product does indeed have a therapeutic effect; that it is manufactured to acceptable standards; and that it does not bring undue hazard to patients with use. A subsequent appraisal process considers if and where society might rationally bring the intervention into usage. It may be efficient for a health system to adopt a less effective but less costly treatment where overall limited resources may be allocated in such a way as to achieve greater health benefit. In this article, I consider aspects of the statistical synthesis of evidence intended to support decisions on pharmaceutical reimbursement.

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The evidence for beta blockers in heart failure

Cited by 92 publications

References 10 publications

Cardiac resynchronisation for patients with heart failure due to left ventricular systolic dysfunction — a systematic review and meta‐analysis

Cardiac resynchronisation for patients with heart failure due to left ventricular systolic dysfunction — a systematic review and meta‐analysis

Secondary Prevention Measures after Acute Myocardial Infarction: Comparison between Diabetics and Non-Diabetics at a Saudi Teaching Hospital

Biostatistical aspects for the use of evidence based medicine in health technology assessment

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