Effect of Beta Blockers on Exercise Capacity, Diastolic Function, and Quality of Life in Patients with Heart Failure with Preserved Ejection Fraction: A Secondary Analysis of INDIE-HFpEF and RELAX

Background

The use of beta blockers in patients with heart failure with preserved ejection fraction (HFpEF) is common, with about 75% of patients in recent landmark clinical trials on beta blockers. Though the implementation of this medication class is routine, there is sparse data to support their use. Furthermore, beta blocker effects on exercise capacity, diastolic function, and quality of life in HFpEF patients is unclear.

Methods

A retrospective cohort study was completed using patient-level data from two prior randomized trials. Cohorts were generated based on beta blocker use at the time of trial enrollment, demographic information was compared. Primary outcomes assessed were exercise capacity, diastolic function, and quality of life metrics. The results of baseline testing were utilized to avoid potential bias from each trial’s intervention.

Results

After multivariate linear regression, HFpEF patients on beta blockers had no difference in exercise capacity (peak VO2 (mL/kg/min): 12.5 vs 13.5, P=0.933), diastolic function (average E/e’: 16 vs 14, P=0.125; left atrial volume index (mL/m2): 47 vs 42, P=0.665; peak tricuspid regurgitation velocity (m/s): 2.85 vs 2.70, P=0.165), or quality of life survey scores (KCCQ: 54 vs 60, P=0.206; MLHFQ 44 vs 48, P=0.762) compared to those not taking beta blockers.

Conclusions

In this secondary analysis of patient-level data, there was no association with beta blocker use and worsened exercise capacity, diastolic function, or quality of life in HFpEF patients. Randomized controlled trials are necessary to definitively determine the clinical and functional impact of beta blockers in HFpEF.

RESEARCH PERSPECTIVE

• In this secondary analysis or INDIE-HFpEF and RELAX, there was no significant association with beta blocker use and worsened exercise capacity, diastolic dysfunction, or quality of life in HFpEF patients.

• With little available evidence to suggest clinical or functional benefits from implementation of beta blockers in HFpEF, randomized controlled trials are warranted to more definitively evaluate the potential effects of this medication class.

• Evaluating unique HFpEF phenotypes with different comorbidity profiles would provide specific insights that could be translated to the clinical management of HFpEF patients.