Beta‐blocker therapy in advanced heart failure: clinical characteristics and long‐term outcomes

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Abstract
Aims: To evaluate the clinical characteristics and long‐term outcomes of advanced heart failure patients (NYHA Class IIIb–IV) receiving beta‐blocker therapy vs. those patients not receiving beta‐blockers at randomization in the FIRST trial, a randomized, double‐blind, placebo‐controlled trial of epoprostenol vs. usual care in advanced heart failure.Methods and results: The patient population consisted of 471 patients enrolled in FIRST with Class IIIb–IV heart failure, left ventricular ejection fraction (LVEF) of < 30%, advanced hemodynamic abnormalities, and standard pharmacologic treatment of ACE‐inhibitor, diuretics, and/or digoxin. The study cohort consisted of 448 patients not receiving beta‐blockers and 23 patients receiving beta‐blockers at randomization for the FIRST trial. Patients in the beta‐blocker group had decreased rates of any clinical event (P = 0.03), worsening heart failure (P = 0.001), and death or worsening heart failure (P = 0.0008) than patients not receiving beta‐blockers. After adjusting for prognostically important variables, the favorable effect of beta‐blockers on worsening heart failure (P = 0.02) and death or worsening heart failure (P = 0.02) persisted.Conclusion: Patients with advanced heart failure who receive beta‐blocker therapy have a lower rate of hospitalization and are less likely to experience worsening heart failure or death at 6 months than patients who are not treated with beta‐blockers. These observational data contribute to the growing body of data demonstrating a favorable effect of beta‐blockers on clinical outcomes in heart failure.