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Adverse Effects of  -Blocker Therapy for Patients With Heart Failure
A Quantitative Overview of Randomized Trials
Dennis T. Ko, MD;
Patricia R. Hebert, PhD;
Christopher S. Coffey, PhD;
Jeptha P. Curtis, MD;
JoAnne M. Foody, MD;
Artyom Sedrakyan, MD;
Harlan M. Krumholz, MD
Arch Intern Med. 2004;164:1389-1394.
Background  -Blockers substantially improve survival in patients with chronic heart failure (HF) with left ventricular systolic dysfunction, but concerns about cardiovascular adverse effects may deter physicians from prescribing this therapy. We performed an overview of randomized -blocker trials in patients with HF to quantify the risks of these adverse effects.
Methods Heart failure trials of -blockers were identified by electronic searches of the MEDLINE database from 1966 to 2002. The random-effects model was used to combine results from individual trials and calculate estimates of risks associated with therapy.
Results -Blocker therapy was associated with significant absolute annual increases in risks of hypotension (11 per 1000; 95% confidence interval [CI], 0-22), dizziness (57 per 1000; 95% CI, 11-104), and bradycardia (38 per 1000; 95% CI, 21-54). There was no significant absolute risk of fatigue associated with therapy (3 per 1000; 95% CI, –2 to 9). -Blocker therapy was associated with a reduction in all-cause withdrawal of medication (14 per 1000; 95% CI, –2 to 29) as well as significant reductions in all-cause mortality (34 per 1000; 95% CI, 20-49), HF hospitalizations (40 per 1000; 95% CI, 22-58), and worsening HF (52 per 1000; 95% CI, 10-94).
Conclusions Although -blocker therapy was associated with hypotension, dizziness, and bradycardia, the absolute increases in risk were small, and overall fewer patients were withdrawn from -blocker therapy than from placebo. This information should alleviate concerns about prescribing this life-saving therapy to patients with HF.
From the Division of Cardiology, Schulich Heart Centre, and the Department of Medicine, Sunnybrook & Women's College Health Sciences Center, University of Toronto, Toronto, Ontario (Dr Ko); Sections of Cardiovascular Medicine, Department of Medicine (Drs Hebert, Curtis, Foody, and Krumholz), and Health Policy and Administration, Department of Epidemiology & Public Health (Dr Krumholz), Yale University School of Medicine, New Haven, Conn; Yale–New Haven Hospital Center for Outcomes Research and Evaluation, New Haven (Dr Krumholz); Department of Biostatistics, University of Alabama at Birmingham (Dr Coffey); and Health Services Research Unit, London School of Hygiene and Tropical Medicine and Clinical Effectiveness Unit, Royal College of Surgeons of England, London, England (Dr Sedrakyan). The authors have no relevant financial interest in this article.
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