Prognostic role of \u3b2-blocker selectivity and dosage regimens in heart failure patients. Insights from the MECKI score database

AIMS: The use of \u3b2-blockers represents a milestone in the treatment of heart failure with reduced ejection fraction (HFrEF). Few studies have compared \u3b2-blockers in HFrEF, and there is little data on the effects of different doses. The present study aimed to investigate in a large database of HFrEF patients (MECKI score database) the association of \u3b2-blocker treatment with a composite outcome of cardiovascular death, urgent heart transplantation or left ventricular assist device implantation, addressing the role of \u3b2-selectivity and dosage regimens. METHODS AND RESULTS: In 5242 HFrEF patients, we investigated the role of: (i) \u3b2-blocker treatment vs. non-\u3b2-blocker treatment, (ii) \u3b21-/\u3b22-receptor-blockers vs. \u3b21-selective blockers, and (iii) daily \u3b2-blocker dose. Patients were followed for 3.58\u2009years, and 1101 events (18.3%) were observed; 4435 patients (86.8%) were on \u3b2-blockers, while 807 (13.2%) were not. At 5\u2009years, \u3b2-blocker-patients showed a better outcome than non-\u3b2-blocker-subjects [hazard ratio (HR) 0.48, P\u20092\u20095\u2009mg carvedilol equivalent daily dose, n\u2009=\u20091005) patients than in both medium dose (12.5-25\u2009mg, n\u2009=\u20091431) and low dose (<12.5\u2009mg, n\u2009=\u20091960) (HR 1.97, P\u2009<\u20090.001; HR 1.95, P\u2009=\u20090.001, respectively), with no differences between the last two groups (HR 0.84, P\u2009=\u2009ns). CONCLUSION: In a large population of chronic HFrEF patients, \u3b2-blockers were associated with a more favourable prognosis without any difference between \u3b21- and \u3b22-receptor-blockers vs. \u3b21-selective blockers. A better outcome was observed in subjects receiving a high daily dose