Do β-blockers improve one-year survival in heart failure patients with atrial fibrillation? Results from the ESC-HF Registry.

Introduction The positive effect of β-blockers therapy in patients with heart failure (HF) and atrial fibrillation (AF) is being questioned. Objectives Assessment of the effect of β-blockers in patients with HF and AF and analysis of the influence of heart rate (HR) control on one-year outcomes in HF-AF patients. Patients and methods Out of 2 019 Polish patients enrolled in two HF registries of the European Society of Cardiology (Pilot and Long-Term), 797 HF-AF patients were divided into two groups depending on β-blockers use. In an additional analysis, survival of HF-AF patients was compared between following 3 groups: patients with HR <80 bpm, 80-109 bpm and ≥110 bpm. Primary endpoint was all-cause death and secondary endpoint was all-cause death or HF hospitalization. Results In patients treated with β-blockers the primary (10.9% vs. 25.6%; P=0.001) and secondary endpoints (30.6% vs. 44.2%; P=0.02) occurred significantly less frequently than in patients without β-blockers. Lack of β-blockers treatment in HF-AF patients was a predictor of the both endpoints in univariate analysis but remained an independent predictor only of the primary endpoint (Hazard Ratio for β-blockers use: 0.52; 95%CI 0.31-0.89; P=0.02) in multivariate analysis. The primary and secondary endpoints occurred more frequently in patients with HR ≥110 b.p.m., but HR itself was not a predictor of both study endpoints in the univariate analyses. Conclusions β-blockers use might decrease mortality in HF-AF patients, but it seems to have no impact on the risk of HF hospitalization. In the HF-AF patients, HR of ≥110 b.p.m. may be related to worse survival.