Abstract 15704: Exploratory Analysis of the Efficacy of β-blockersin Patients With Post-infarction Systolic Dysfunction Plus Atrial Fibrillation
Introduction: β blocker therapy for patients with acute myocardial infarction (AMI) and reduced left ventricular ejection fraction (LVEF) was instituted after large randomized controlled trials showed a significant reduction in morbidity and mortality rates. Recently, their efficacy in patients with heart failure (HF) and atrial fibrillation (AF) has been questioned, based on the results of a large meta-analysis. We aim to analyze the efficacy of β blocker therapy in patients with post-AMI reduced LVEF and permanent AF.
Methods: We studied all consecutive patients discharged with AMI and LVEF ≤ 40% from Hospital of Santiago de Compostela (2004-12) and Bellvitge Hospital of Barcelona (2009-14). The final cohort included 1,056 patients after excluding those without follow-up data. We analyzed the association between β blockers and follow-up (3.0 ± 2.5 years) mortality using Cox regression, adjusting by all confounding variables and by propensity score.
Results: 782 patients (74.6%) were treated with β blockers. There were prescribed to 67.1% of patients in sinus rhythm (SR) and to 71.4% in AF. 140 patients (13.2%) had permanent AF at discharge.
In SR group, β blockers were associated with lower mortality during follow-up (HR 0.42, 95% CI 0.31-0.53; p<0.001) after adjusting by the confounding variables (HR 0.50, 95% CI 0.32-0.96; p=0.028) and by propensity score (HR 0.68, 95% CI 0.51-0.92; p=0.010), but not in the AF group (HR 0.75, 95% CI 0.45-1.23; P=0.248) after adjusting by the confouding variables (HR 0.67, 95% CI 0.34-1.32; p=0.247) and propensity score (HR 0.81, 95% CI 0.47-1.40; p=0.459).
Conclusion: β blocker therapy has no or minimal effect on mortality in patients with post-infarction reduced LVEF and AF, in contrast with its beneficial effects in SR. Thus, we call into question the preferential use of β blockers compared with other rate-control drugs in these patients (1A) and we emphasize the need for further trials to clarify it.
Author Disclosures: V. González Salvado: None. S. Raposeiras Roubín: None. A. Ariza-Solé: None. E. Abu-Assi: None. G. Muntané: None. A. Garay: None. A. Varela Román: None. J. González-Juanatey: None.
- © 2015 by American Heart Association, Inc.