Heart failure: beta-blockers reduce all-cause mortality in patients with preserved ejection fraction

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  • In patients with heart failure and a left ventricular (LV) ejection fraction ≥40%, beta-blockers reduced all-cause and cardiovascular mortality by 22% and 25%, respectively.
  • Angiotensin-converting-enzyme (ACE) inhibitor, angiotensin receptor blocker (ARB) and mineralocorticoid receptor antagonist (MRA) showed no significant effects on the same outcomes.

Why this matters

  • Beta-blockers should be considered by physicians when there is an existing indication for them.

Key results

  • Compared with placebo, beta-blockers reduced the risk for all-cause (relative risk [RR], 0.78; P=.008) and cardiovascular mortality (RR, 0.75; P=.01).
  • Compared with placebo, pooled analysis of ACE inhibitor (RR, 1.10; P=.46; n=1234), ARB (RR, 1.02; P=.71; n=7257) and MRA (RR, 0.92; P=.32; n=3867) trials showed no effect on all-cause mortality.

Study design

  • 25 randomised controlled trials involving 18,101 patients with heart failure with LV ejection fraction ≥40% met eligibility criteria after a search on Medline, EMBASE and the Cochrane Central Register of Controlled Trials.
  • Funding: British Heart Foundation.


  • Lack of data on patients with an LV ejection fraction between 40% and 49%.