Heart Failure with Preserved Ejection Fraction - To beta-Block or Not to beta-Block

• Published in: Journal of cardiac failure 2019-08, Vol.25 (8), p.S71-S71
• Main Authors: Singh, Tushi, Anand, Rahul, Nandyala, Anisha, Khalifa, Maram, Ameen, Muhammad, Vittorio, Timothy
• Format: Article
• Language: English
• ISSN: 1071-9164; 1532-8414
• DOI: 10.1016/j.cardfail.2019.07.203

Heart failure with reduced ejection fraction (HFrEF) enjoys the luxury of well- established clinical guideline-directed medical therapy (GDMT). However, heart failure with preserved ejection fraction (HFpEF) remains an orphan disease with no clear guidelines. Beta- adrenergic blockade has garnered the most interest owing to previous meta-analyses studies. We undertook a retrospective observational study to measure the effect of beta-blockade in such a population. This was a retrospective observational study from January 1, 2012 to December 31, 2017. We included patients that underwent transthoracic echocardiogram (TTE) at our center either in the inpatient or outpatient settings and which demonstrated a left ventricular ejection fraction (LVEF) of over 50% as well as evidence of diastolic dysfunction. Additionally, patients must have had at least 3 outpatient visits during this time frame. Variables collected included age, gender, ethnicity, LVEF, grade of diastolic dysfunction on TTE, use of beta-adrenergic blocker if any, presence of any baseline arrhythmias, heart rate during three outpatient clinic visits, hospital admissions due to heart failure (HF), complications if any during the admissions and finally death attributable to HF. After a review of over 1500 patients, 625 met the criteria to be included in the study. Approximately 55% were Hispanic, 39% Black, 5% Caucasian and the remaining 1.8% Asian. 90% of the study population had grade 1-2 diastolic dysfunction and 15% had baseline arrhythmias. We found that 27% of the population had a heart rate under 70 bpm at baseline. 62% of the population were treated with beta-adrenergic blockers. When patients were stratified based on beta-adrenergic blockade usage, it was found that the inpatient admission rates for cardiac reasons between the two groups did not differ. The likelihood of requiring critical care services between the two groups was similarly insignificant. Furthermore, the likelihood of death due to cardiovascular causes between the two groups did not differ. Multiple meta-analyses studies have demonstrated a reduction in cardiovascular as well as all-cause mortality in HFpEF. However, observational studies are unable to reproduce similar success. We propose that the use of beta-adrenergic blockade is still up for debate. Undertaking a large multi-center study along the lines proposed by us would settle the debate once and for all.