Effect of Beta-blocker Treatment on VO<inf>2peak</inf> in Patients with Heart Failure

Abstract

© 2018 by the American College of Sports Medicine. Purpose In addition to prolonged life and reduced hospitalization rates, it is currently unclear whether beta-blocker (BB) treatment modulates peak oxygen consumption (VO2peak), a hallmark of exercise capacity, in patients with heart failure (HF). The main aim of this study is to determine the effect of BB treatment on VO2peak in HF patients. Methods We conducted a systematic search of MEDLINE, Scopus, and Web of Science since their inceptions until March 2017 for randomized controlled trials (RCT) assessing the effect of BB treatment on VO2peak in chronic HF patients. A meta-analysis was performed to ascertain the standardized mean difference (SMD) between the effects of BB and placebo treatment on VO2peak. Secondary outcomes included peak exercise performance and New York Health Association functional class. Subgroup and meta-regression analyses assessed potential moderating factors. Results Fourteen RCT met the inclusion criteria (overall n = 616). Interventions comprised BB (n = 324) or placebo (n = 292) administration lasting 3 to 24 months. Concomitant reported medication did not differ between HF patients assigned to BB and placebo groups. After data pooling, VO2peak was preserved with BB compared with placebo treatment (SMD, -0.04; 95% confidence interval (CI), -0.20 to 0.12; P = 0.61); heterogeneity among studies was not detected (I2 = 0%, P = 0.88). Peak exercise performance was not altered (SMD, 0.02; 95% CI, -0.16 to 0.20; P = 0.85), whereas New York Health Association functional class was reduced with BB compared with placebo (SMD, -0.54; 95% CI, -0.90 to -0.18; P = 0.003). Conclusions According to evidence from RCT, prolonged BB (B1-selective or nonselective) treatment does not affect VO2peak but improves functional status in HF patients.