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Clinical Research in Cardiology

, Volume 106, Issue 9, pp 711–721 | Cite as

Bisoprolol compared with carvedilol and metoprolol succinate in the treatment of patients with chronic heart failure

  • Hanna Fröhlich
  • Lorella Torres
  • Tobias Täger
  • Dieter Schellberg
  • Anna Corletto
  • Syed Kazmi
  • Kevin Goode
  • Morten Grundtvig
  • Torstein Hole
  • Hugo A. Katus
  • John G. F. Cleland
  • Dan Atar
  • Andrew L. Clark
  • Stefan Agewall
  • Lutz FrankensteinEmail author
Original Paper

Abstract

Aims

Beta-blockers are recommended for the treatment of chronic heart failure (CHF). However, it is disputed whether beta-blockers exert a class effect or whether there are differences in efficacy between agents.

Methods and results

6010 out-patients with stable CHF and a reduced left ventricular ejection fraction prescribed either bisoprolol, carvedilol or metoprolol succinate were identified from three registries in Norway, England, and Germany. In three separate matching procedures, patients were individually matched with respect to both dose equivalents and the respective propensity scores for beta-blocker treatment. During a follow-up of 26,963 patient-years, 302 (29.5%), 637 (37.0%), and 1232 (37.7%) patients died amongst those prescribed bisoprolol, carvedilol, and metoprolol, respectively. In univariable analysis of the general sample, bisoprolol and carvedilol were both associated with lower mortality as compared with metoprolol succinate (HR 0.80, 95% CI 0.71–0.91, p < 0.01, and HR 0.86, 95% CI 0.78–0.94, p < 0.01, respectively). Patients prescribed bisoprolol or carvedilol had similar mortality (HR 0.94, 95% CI 0.82–1.08, p = 0.37). However, there was no significant association between beta-blocker choice and all-cause mortality in any of the matched samples (HR 0.90; 95% CI 0.76–1.06; p = 0.20; HR 1.10, 95% CI 0.93–1.31, p = 0.24; and HR 1.08, 95% CI 0.95–1.22, p = 0.26 for bisoprolol vs. carvedilol, bisoprolol vs. metoprolol succinate, and carvedilol vs. metoprolol succinate, respectively). Results were confirmed in a number of important subgroups.

Conclusion

Our results suggest that the three beta-blockers investigated have similar effects on mortality amongst patients with CHF.

Keywords

Beta-blocker Heart failure with reduced ejection fraction Survival Effectiveness 

Notes

Compliance with ethical standards

Funding sources

This work was supported from the AOK Baden-Württemberg, Germany, within the scope of the junior researcher’s academy “health care research Baden-Württemberg, Germany”.

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

All patients gave their written informed consent for data storage and evaluation. The study conformed to the principles outlined in the Declaration of Helsinki and was approved by the local ethics committees. Patients’ data were pseudonymised for analyses.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  • Hanna Fröhlich
    • 1
  • Lorella Torres
    • 1
  • Tobias Täger
    • 1
  • Dieter Schellberg
    • 1
  • Anna Corletto
    • 1
  • Syed Kazmi
    • 2
  • Kevin Goode
    • 9
  • Morten Grundtvig
    • 3
  • Torstein Hole
    • 4
    • 5
  • Hugo A. Katus
    • 1
  • John G. F. Cleland
    • 6
    • 7
  • Dan Atar
    • 8
  • Andrew L. Clark
    • 2
  • Stefan Agewall
    • 8
  • Lutz Frankenstein
    • 1
    Email author
  1. 1.Department of Cardiology, Angiology and Pulmology, University Hospital HeidelbergUniversity of HeidelbergHeidelbergGermany
  2. 2.Castle Hill HospitalHull York Medical SchoolHullUK
  3. 3.Medical DepartmentInnlandet Hospital Trust Division LillehammerLillehammerNorway
  4. 4.Medical FacultyNorwegian University of Science and Technology (NTNU)TrondheimNorway
  5. 5.Medical ClinicHelse Møre and Romsdal HFÅlesundNorway
  6. 6.National Heart and Lung Institute, Royal BromptonHarefield Hospitals, Imperial CollegeLondonUK
  7. 7.Robertson Centre for Biostatistics & Clinical TrialsGlasgowUK
  8. 8.Department of Cardiology, Oslo University Hospital, Ulleval and Institute of Clinical SciencesUniversity of OsloOsloNorway
  9. 9.Hull York Medical SchoolUniversity of HullHullUK

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