Beta-blocker withdrawal improves functional capacity in HFpEF

Withdrawal of beta-blocker treatment has led to increased maximal functional capacity in patients with heart failure with preserved ejection fraction (HFpEF) and chronotropic incompetence, reports a recent study, noting how use of beta-blockers deserved re-evaluation.

A team of investigators conducted a multicentre, randomized, blinded, crossover clinical trial consisting of two treatment periods of 2 weeks, separated by a washout period of 2 weeks to evaluate the effect of β-blocker withdrawal on peak oxygen consumption (peak VO₂).

Patients with stable HFpEF, New York Heart Association (NYHA) functional classes II and III, previous treatment with β-blockers, and chronotropic incompetence were first randomly assigned to withdrawing from (arm A: n=26) or continuing (arm B: n=26) beta-blocker treatment and were then crossed over to receive the opposite intervention.

The investigators measured changes in peak VO₂ and percentage of predicted peak VO₂ (peak VO₂%) at the end of the trial. They also performed a linear mixed regression analysis to account for the paired-data nature of this crossover trial.

Patients had a mean age of 72.6±13.1 years and were mostly women (59.6 percent) in NYHA functional class II (66.7 percent). The mean peakVO₂ and peak VO₂% were 12.4±2.9 mL/kg/min and 72.4±17.8 percent, respectively. No significant baseline differences were noted across treatment groups.

After beta-blocker withdrawal, both peak VO₂ (14.3 vs 12.2 mL/kg/min [Δ +2.1 mL/kg/min]; p<0.001) and peak VO₂% (81.1 vs 69.4 percent [Δ +11.7 percent]; p<0.001) significantly increased.

“Chronotropic incompetence has [been] shown to be associated with a decrease in exercise capacity HFpEF, yet β-blockers are commonly used in HFpEF despite the lack of robust evidence,” the investigators said.