Several large trials have shown that beta-blocker treatment reduces the risk of death and hospital admission in patients with symptomatic heart failure. Unfortunately, survey data suggests relatively poor utilisation of beta-blockers, despite ample evidence for good tolerability. Additionally there are several important unanswered questions, such as clinical efficacy for specific sub-populations (women, the elderly and patients with diabetes or other co-morbidities) and the effect of beta-blockers in combination with other medications. Previous meta-analyses, based on published tabular data, have been conducted although this approach has important biases and limitations. We plan to perform a carefully conducted systematic review of individual patient data from the major randomised trials of beta-blockers in heart failure. The goals of this collaborative project are to clarify the overall efficacy of beta-blockers and identify sub-groups that show particular benefit, thereby increasing the use of beta-blockers, reducing adverse clinical outcomes and the high costs associated with this condition.
Study Type
OBSERVATIONAL
Enrollment
18,240
as determined by individual study
in addition to usual care
Clinical Trials & Evaluation Unit, Royal Brompton Hospital
London, United Kingdom
Centre for Statistics in Medicine, University of Oxford
Oxford, United Kingdom
Beta-blocker therapy improves overall mortality and morbidity in symptomatic heart failure in an individual patient meta-analysis
Time frame: variable (time to event)
Beta-blocker therapy improves mortality and morbidity in both elderly patients and women
Time frame: variable (time to event)
Beta-blocker therapy improves mortality and morbidity in patients with co-morbidities (diabetes, renal dysfunction, COPD, peripheral arterial disease or atrial fibrillation)
Time frame: variable (time to event)
The benefit of beta-blockers is not modified by concomitant cardiovascular therapy
Time frame: variable (time to event)
The benefit of beta-blockers is independent of left ventricular ejection fraction at baseline
Time frame: variable (time to event)
The clinical benefit is dependent on the resting heart rate achieved whatever the dose achieved or agent used
Time frame: variable (time to event)
Adverse side effects of beta blocker therapy do not significantly impact on clinical benefit (as a whole and in relevant sub-groups)
Time frame: variable (time to event)
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