Effects Of Beta-blocker In Heart Failure Patients With Left Ventricular Ejection Fraction≥40%:A Multicenter,Randomized Study

Objective:To investigate the long-term efficacy of metoprolol succinate in patients with heart failure with preserved ejection fraction and mid-range ejection fraction.Methods:The beta-PRESERVE study is a prospective,multicenter,randomized trial.We enrolled heart failure patients(LVEF≥40%,NT-proBNP≥1500 pg/mL,and history of hospitalization for worsening heart failure more than three months ago)in this trial and randomized to the group either with or without metoprolol succinate which was initiated at 23.75mg daily and then up-titrated during study.All the patients were stable on medication with background heart failure therapy for at least than 2 weeks prior to randomization.The primary endpoint was a composite of cardiovascular death or unplanned rehospitalization for worsening heart failure,and the secondary endpoints were hospitalization for all-and cardiovascular causes.Results:A total of 258 patients with heart failure were enrolled in 21 public tertiary hospitals nationwide from February 2007 to September 2012 with 133 randomized into the metoprolol succinate(the metoprolol group)and 125 in the group without succinate metoprolol(the control group).The median follow-up time was 2 years.There was no significant difference in the combined incidence of cardiovascular death or unplanned hospitalization for heart failure between the two groups(HR 0.72,95%CI0.43 to 1.21,P=0.21).The relative risk of the all-cause hospitalization was 41%lower in the metoprolol group than in the control group(HR 0.59,95%CI036 to 0.94,P=0.03).Risk of cardiovascular hospitalization was also significantly lower in the metoprolol group(HR 0.54,95%CI 0.32 to 0.90,P=0.02).Meanwhile,the metoprolol group showed a decreasing trend of hospitalization for heart failure(HR0.58,95%CI 0.33 to 1.03,P=0.05).Further subgroup analysis suggested that the risk of all-cause readmission in the metoprolol group was significantly lower(HR 0.49,95%CI 0.25-0.98,P=0.04)for patients with HFpEF and there was no significant difference in cardiovascular rehospitalization compared with the control group;for patients with HFmrEF,there was no statistically significant difference in the risk of all endpoint events between the two groups of patients receiving and not receiving metoprolol.Conclusion:Metoprolol succinate did not reduce the risk of cardiovascular death or unplanned rehospitalization for worsening heart failure in patients with HFpEF or HFmrEF.However,significantly lower rate of all-cause and cardiovascular rehospitalization were observed in metoprolol succinate-treated heart failure patients.(Chinese Clinical Trial Register number:Chi CTR-TNC-00000 144.)...