β-Blocker Use and Health Status Among Patients With Heart Failure With Preserved Ejection Fraction

1. In patients with heart failure with preserved ejection fraction (HFpEF), β-blocker use was not associated with concurrent baseline health status or modification of the health status benefit achieved with spironolactone use at 4 months. Evidence Rating Level: 2 (Good) β-blockers have traditionally been used in the management of HFpEF, yet recent studies have suggested that the use of β-blockers in this patient population may be associated with adverse outcomes such as increased risk of heart failure hospitalization. However, the association between β-blockers and patient health status, including symptoms and quality of life, is not well known. This cohort study therefore sought to investigate the association between β-blockers and heart failure-related health status among patients with HFpEF. 1726 patients (mean[SD] age, 71.6[9.7] years; 50.1% male) from the multinational TOPCAT randomized clinical trial were included in this study. Health status was assessed using the Kansas City Cardiomyopathy Questionnaire overall summary score (KCCQ-OS) including various dimensions such as symptoms, quality of life and physical and social functioning. β-blockers at baseline were not significantly associated with concurrent KCCQ-OS (mean difference, −1.1 points [95% CI, −3.7 to 1.4 points]; P = .38), and was not significantly associated with KCCQ-OS at 4 months (mean difference, −2.0 points [95% CI, −4.8 to 0.8 points]; P = .16). Patients receiving spironolactone who were also receiving concurrent β-blockers experienced greater health status improvement compared to those not taking concurrent β-blockers, yet the difference was not statistically significant (P = .20 for interaction). Overall, this study found that the use of β-blockers in the management of HFpEF was not associated with a better or worse baseline health status, nor was it associated with any modification of the health status benefit achieved with the use of spironolactone after 4 months. Click to read the study in JAMA Network Open Image: PD