Saturday, February 17, 2007
bèta-blocker atrium fibrilatie
Beta blockers prevent atrial fibrillation in systolic HF
16 February 2007
Beta blockers appear to prevent atrial fibrillation (AF) in patients with systolic heart failure (HF), say researchers.
Imad Abi Nasr (Assistance Publique-Hôpitaux de Paris, France) and colleagues came to this conclusion after conducting a meta-analysis of seven randomized, placebo-controlled trials including 70% of all HF patients involved in beta-blocker studies.
The benefits of beta blockers in HF may involve prevention of AF, but only one randomized trial directly suggests such an effect, Abi Nasr and team explain. "A systematic review of published and unpublished data is timely and could allow estimating the effectiveness of beta blockers to prevent chronic HF-related AF," they write.
The team looked for all studies that provided information on the incidence of AF during follow-up among those patients in sinus rhythm at baseline.
This revealed seven studies, including 11,952 patients who were receiving background treatment with angiotensin-converting enzyme inhibitors.
During an average follow-up period of 1.35 years, there were 227 versus 313 incident cases of AF in the beta-blocker and placebo arms, respectively. These translated into AF incidences of 28 per 1000 patient-years in the beta-blockers arm and 39 per 1000 patient-years in the placebo arm.
Analysis of this data indicated that beta-blockers significantly reduced the incidence of AF onset, with a relative risk (RR) reduction of 27% (RR=0.73, p<0.001).
Robustness analysis ruled out the possibility of publication bias, owing to the inclusion of unpublished neutral trials, the authors note.
A similar effect was seen with non-selective and selective beta blockers, according to heterogeneity tests, provided one trial – the SENIORS trial – was excluded. An old population (>70 years), a higher prevalence of baseline AF, and a high proportion of patients with diastolic HF may explain the absence of effect in SENIORS, Abi Nasr et al comment.
"Our meta-analysis suggests that beta blockers should be used as the first-line agents on preventing occurrence or recurrence of HF-related AF, with a similar and additional benefit in comparison with ACE-inhibitors and angiotensin II receptor antagonists," the authors conclude.
Eur Heart J 2007; 28: 457-462
16 February 2007
Beta blockers appear to prevent atrial fibrillation (AF) in patients with systolic heart failure (HF), say researchers.
Imad Abi Nasr (Assistance Publique-Hôpitaux de Paris, France) and colleagues came to this conclusion after conducting a meta-analysis of seven randomized, placebo-controlled trials including 70% of all HF patients involved in beta-blocker studies.
The benefits of beta blockers in HF may involve prevention of AF, but only one randomized trial directly suggests such an effect, Abi Nasr and team explain. "A systematic review of published and unpublished data is timely and could allow estimating the effectiveness of beta blockers to prevent chronic HF-related AF," they write.
The team looked for all studies that provided information on the incidence of AF during follow-up among those patients in sinus rhythm at baseline.
This revealed seven studies, including 11,952 patients who were receiving background treatment with angiotensin-converting enzyme inhibitors.
During an average follow-up period of 1.35 years, there were 227 versus 313 incident cases of AF in the beta-blocker and placebo arms, respectively. These translated into AF incidences of 28 per 1000 patient-years in the beta-blockers arm and 39 per 1000 patient-years in the placebo arm.
Analysis of this data indicated that beta-blockers significantly reduced the incidence of AF onset, with a relative risk (RR) reduction of 27% (RR=0.73, p<0.001).
Robustness analysis ruled out the possibility of publication bias, owing to the inclusion of unpublished neutral trials, the authors note.
A similar effect was seen with non-selective and selective beta blockers, according to heterogeneity tests, provided one trial – the SENIORS trial – was excluded. An old population (>70 years), a higher prevalence of baseline AF, and a high proportion of patients with diastolic HF may explain the absence of effect in SENIORS, Abi Nasr et al comment.
"Our meta-analysis suggests that beta blockers should be used as the first-line agents on preventing occurrence or recurrence of HF-related AF, with a similar and additional benefit in comparison with ACE-inhibitors and angiotensin II receptor antagonists," the authors conclude.
Eur Heart J 2007; 28: 457-462
# posted by roodbont @ 1:39 AM 
