The prognostic impact of cardioselectivity of beta-blockers prescribed during hospitalization for decompensated heart failure.

Background Beta-blockers (BBs) show considerable variation in cardioselectivity (i.e., the relative affinity to the β ₁ receptor), even among those with evidence of benefit in the treatment of chronic heart failure (HF). We aimed to evaluate whether the cardioselectivity of BBs prescribed at discharge from hospitalization for decompensated HF will affect the long-term prognosis of patients. Methods In the prospective study, we followed 4053 patients hospitalized for decompesated HF. The entire cohort was divided into subgroups based on the cardioselectivity of the BBs prescribed at discharge. Results After complex adjustment, patients treated with a highly selective BBs (bisoprolol) showed significantly lower five-year cardiovascular mortality than those with a lesser degree of cardioselectivity (mainly metoprolol) [HRR 0.69 (95%CIs:0.52–0.92), p = 0.011]. This difference remained in patients with HF with reduced ejection fraction (HFrEF) [HRR 0.58 (95%CIs:0.37–0.89), p = 0.013], but was not yet significant in HF with preserved ejection fraction [HRR 0.66 (95%CIs:0.43–1.02), p = 0.063]. In HFrEF patients only, highly cardioselective BBs also showed a lower risk of cardiovascular mortality than nonselective BBs with α-blocking activity (mainly carvedilol) [HRR 0.55 (95%CIs:0.33–0.93, p = 0.025]. Conclusion The choice of a beta-blocker regarding the degree of its cardioselectivity may have a prognostic impact in chronic HF patients.