Effect of beta-blocker therapy on functional status in patients with heart failure - A meta-analysis

Background: The results of randomised control trials (RCTs) evaluating the effect of beta-blockers on functional status in patients with chronic heart failure are conflicting. Aim: To perform a systematic review and meta-analysis of RCTs evaluating the effect of beta-blockers on New York Heart Association (NYHA) classification and exercise tolerance in chronic heart failure. Methods and results: We selected 28 RCTs evaluating beta-blocker versus placebo in addition to ACE inhibitor therapy. Combined results of 23 RCTs showed that beta-blockers improved NYHA class by at least one class with odds ratio (OR) 1.80 (1.33-2.43)p < 0.0001. Metaanalysis of 10 RCTs showed a significant prolongation of exercise time by44.19 (6.62-81.75) sp=0.021. Combining 8 RCTs evaluatingthe maximal peak oxygen uptake and 9 RCTs evaluating 6-min walk distance showed that beta-blockers had no significant effect compared with placebo, p =0.484, and p =0.730, respectively. Combined results of the 23 RCTs showed significant reducing effect on all cause mortality with OR=0.69 (0.59-0.82)p < 0.0001. Conclusion: Chronic use of a beta-blocker in conjunction with ACE inhibitor therapy improves dyspnoea and prolongs exercise tolerance time, but has no significant effect on 6-min walk test or maximal oxygen uptake in patients with heart failure. (c) 2005 European Society of Cardiology. Published by Elsevier B.V. All rights reserved.