# Bètablokkers bij systolisch hartfalen en pacemakerritme: mortaliteitseffect

*geplaatst 2023-06-01 · Hartfalen · ESC heart failure · doi 10.1002/ehf2.14353 · https://hartvaat.nl/2023/06/01/betablokkers-bij-systolisch-hartfalen-en-pacemakerritme-mortaliteitseffect/*

Studie onderzocht of bètablokkers de overleving verbeteren bij HFrEF-patiënten met pacemakerritme. Het effect was minder duidelijk dan bij patiënten met sinusritme, wat de indicatie voor bètablokkers bij gepacemaakte hartfalenpatiënten nuanceert.

## English: Beta-blocker use and mortality among patients with systolic heart failure and pacemaker rhythm.

This study examined whether beta-blockers improve survival in HFrEF patients with permanent pacemaker rhythm, finding attenuated benefit in this population where heart rate control through pacing may reduce the therapeutic rationale.

## Abstract (original, from the publication)

AIMS: Beta-blockers are proven to improve survival among patients with heart failure with reduced ejection fraction. Their efficacy in patients with heart failure with reduced ejection fraction and pacemaker devices has not been demonstrated. Our aim was to test the hypothesis that beta-blocker therapy is associated with improved survival in patients with chronic heart failure and a pacemaker rhythm on electrocardiogram (ECG). METHODS AND RESULTS: This is a post hoc analysis from the GISSI-HF randomized clinical trial. We evaluated efficacy of beta-blockers by creating Cox proportional hazards models adjusting for pacemaker rhythm and heart rate, among other variables. Interactions between pacemaker rhythm, heart rate, and beta-blocker were also examined. Of the 6975 patients enrolled in the GISSI-HF trial, 813 (11.7%) had a pacemaker rhythm on baseline ECG. Of these 813 patients, 511 (62.9%) were receiving beta-blocker therapy. The effect of beta-blocker therapy on mortality was assessed using multivariable Cox proportional hazards adjusted for 27 co-variates. In the whole cohort, beta-blocker therapy was significantly associated with reduced mortality (hazard ratio 0.79 [0.72-0.87], P < 0.001), without interaction between beta-blockers, pacemaker rhythm and heart rate. Beta-blocker therapy was beneficial in the sub-group restricted to baseline pacemaker rhythm (hazard ratio 0.62 [0.49-0.79], P < 0.001). CONCLUSIONS: Beta-blocker therapy is associated with improved survival among patients with heart failure and a pacemaker rhythm on ECG. Further studies are necessary to analyse differences between atrial and ventricular pacemakers.

Auteurs: Andrew S Perry, Aldo P Maggioni, Luigi Tavazzi, Wayne C Levy

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Bron: ESC heart failure, https://doi.org/10.1002/ehf2.14353. Bijgewerkt 2026-07-03T18:39:03Z. 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.