Abstract 10963: Comparable Benefit of Beta-Blocker Therapy in Heart Failure across Regions of the World: Meta-Analysis of Randomized Clinical Trials
Hypothesis: There exists variability in clinical outcomes noted with use of beta-blocker therapy (BBT) in patients with heart failure with reduced ejection fraction (HFrEF) from North America (NA) compared with other regions of the world (ROW).
Methods: We conducted a systematic review and meta-analysis using MEDLINE, EMBASE, Cochrane Library, Web of Science, and Scopus (inceptions-December 2012) of BBT RCTs stratified by NA vs ROW. RCTs of BBT in HFrEF were identified reporting mortality outcomes stratified by geographic location.The primary endpoint was all-cause mortality and secondary endpoints were cardiovascular death, sudden death, death due to pump failure, and premature drug discontinuation. Summary odds ratios (OR) and 95% confidence intervals (CI) for each outcome were calculated using a random effects model comparing BBT with placebo/control with interaction terms for region.Also our results were a-priori planned to be tested with trial sequential analysis and heterogeneity explorations.
Results: The analysis included 16 RCTs with 15,646 patients, 7 trials in NA and 9 trials in ROW. All-cause mortality was consistently reduced in NA (OR 0.48, 95% CI, 0.29-0.82, P=0.007) and ROW (OR 0.76, 95% CI, 0.69-0.84, P<0.001; P-interaction=0.10). Overall and by region, all secondary endpoints including premature drug discontinuation were also significantly less with BBT (P-interactions all ≥0.10). Trial Sequential analysis and a-priori planned heterogeneity explorations of differential baseline co-variates and percentages of african-americans in the trials affirmed validity.
Limitations: Post-hoc analysis of RCT data.
Conclusions: There is no evidence to suggest that geographic region is a significant moderator of clinical outcomes with BBT in HFrEF patients. These findings highlight the robust data supporting global use of BBT in HFrEF.
- © 2013 by American Heart Association, Inc.