{"id":"80f575fd61fa","type":"article","url":"https://hartvaat.nl/2018/01/01/betablokkers-bij-hfref-hfmref-en-hfpef-individuele-patientanalyse/","title":"Bètablokkers bij HFrEF, HFmrEF en HFpEF: individuele patiëntanalyse","title_en":"Beta-blockers for heart failure with reduced, mid-range, and preserved ejection fraction: an individual patient-level analysis of double-blind randomized trials.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen","bisoprolol","bloeddrukbehandeling","dapa-hf","step-hfpef","summit-trial"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehx564","source_url":"https://doi.org/10.1093/eurheartj/ehx564","authors":["John G F Cleland","Karina V Bunting","Marcus D Flather","Douglas G Altman","Jane Holmes","Andrew J S Coats","Luis Manzano","John J V McMurray","Frank Ruschitzka","Dirk J van Veldhuisen","Thomas G von Lueder","Michael Böhm","Bert Andersson","John Kjekshus","Milton Packer","Alan S Rigby","Giuseppe Rosano","Hans Wedel","Åke Hjalmarson","John Wikstrand","Dipak Kotecha"],"significance":8,"published":"2018-01-01","source_date":"2018-01-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/hfmref-hartfalen-met-matig-verminderde-ejectie/","https://hartvaat.nl/kennis/hartfalen/betablokkers-bij-hartfalen/"],"congress":"","summary_en":"This individual patient-level analysis across multiple trials demonstrated that beta-blockers significantly reduce mortality in HFrEF but showed no benefit in patients with mid-range or preserved ejection fraction. The analysis defined the EF boundary below which beta-blocker therapy is effective.","created":"2026-07-03T10:27:05Z","updated":"2026-07-03T13:26:21Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Individuele patiëntanalyse van meerdere trials naar het effect van bètablokkers bij alle drie de HF-fenotypen. Bevestigt voordeel bij HFrEF in sinusritme maar niet bij HFpEF.","abstract_original":"AIMS: Recent guidelines recommend that patients with heart failure and left ventricular ejection fraction (LVEF) 40-49% should be managed similar to LVEF ≥ 50%. We investigated the effect of beta-blockers according to LVEF in double-blind, randomized, placebo-controlled trials. METHODS AND RESULTS: Individual patient data meta-analysis of 11 trials, stratified by baseline LVEF and heart rhythm (Clinicaltrials.gov: NCT0083244; PROSPERO: CRD42014010012). Primary outcomes were all-cause mortality and cardiovascular death over 1.3 years median follow-up, with an intention-to-treat analysis. For 14 262 patients in sinus rhythm, median LVEF was 27% (interquartile range 21-33%), including 575 patients with LVEF 40-49% and 244 ≥ 50%. Beta-blockers reduced all-cause and cardiovascular mortality compared to placebo in sinus rhythm, an effect that was consistent across LVEF strata, except for those in the small subgroup with LVEF ≥ 50%. For LVEF 40-49%, death occurred in 21/292 [7.2%] randomized to beta-blockers compared to 35/283 [12.4%] with placebo; adjusted hazard ratio (HR) 0.59 [95% confidence interval (CI) 0.34-1.03]. Cardiovascular death occurred in 13/292 [4.5%] with beta-blockers and 26/283 [9.2%] with placebo; adjusted HR 0.48 (95% CI 0.24-0.97). Over a median of 1.0 years following randomization (n = 4601), LVEF increased with beta-blockers in all groups in sinus rhythm except LVEF ≥50%. For patients in atrial fibrillation at baseline (n = 3050), beta-blockers increased LVEF when < 50% at baseline, but did not improve prognosis. CONCLUSION: Beta-blockers improve LVEF and prognosis for patients with heart failure in sinus rhythm with a reduced LVEF. The data are most robust for LVEF < 40%, but similar benefit was observed in the subgroup of patients with LVEF 40-49%."}