Evidence map›Paper›PMID 23796325›Full record

SynthesisInternational journal of cardiology2013

Systematic review of genuine versus spurious side-effects of beta-blockers in heart failure using placebo control: recommendations for patient information.

Anthony J Barron, Nabeela Zaman, Graham D Cole, Roland Wensel, Darlington O Okonko, Darrel P Francis

Registry-linked trialOpen access · greenAbstract readSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in International journal of cardiology, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT07029906 (pErsonalised Nocebo Assessment of Beta-blockEr Symptoms in Heart Failure), which is not on this map. Cited by 38 papers, 5 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
38citing papers in PubMed, 5 pooled it
5.9field-weighted citation impact, top 3% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT07029906 narecruitingnot on this mapstarted 2025, after this paper: background citation

pErsonalised Nocebo Assessment of Beta-blockEr Symptoms in Heart Failure

TypeinterventionalSponsorImperial College LondonRan2025 to 2027Enrolled150ConditionsSide-Effect, Heart FailureArmsBisoprolol 2.5 mg, Placebo
3 · Its place in the literature

Who cites it

38 citing papers in PubMed, 5 syntheses or guidelines pooled it, 116 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Pooled it
  5. Pooled it
  6. Trial
  7. Side Effect Patterns in a Crossover Trial of Statin, Placebo, and No Treatment.Journal of the American College of Cardiology · 2021
    Trial
  8. Trial
  9. Article
  10. Article
  11. Review
  12. Review
  13. Article
  14. Article
  15. Antidotal and protective effects of mangosteen (Iranian journal of basic medical sciences · 2023
    Review
  16. Review
  17. Review
  18. Observational
  19. Review
  20. Observational
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors at 4 institutions in 1 country.

Anthony J BarronNational Heart and Lung Institute, Imperial College London, UK; St Mary's Hospital, Imperial College Healthcare NHS Trust, UK. Electronic address: anthonybarron@hotmail.co.uk.
Nabeela Zaman
Graham D Cole
Roland Wensel
Darlington O Okonko
Darrel P Francis
Imperial College Healthcare NHS Trust · GBSt. Mary's Hospital · GBImperial College London · GBWatford General Hospital · GB

Funding

British Heart Foundation FS/10/038British Heart Foundation FS/10/38/28268British Heart Foundation FS/12/12/29294British Heart Foundation PG/11/36/28883
6 · The paper itself

Abstract

backgroundPatients trying life-preserving agents such as beta-blockers may be discouraged by listings of harmful effects provided in good faith by doctors, drug information sheets, and media. We systematically review the world experience of side-effect information in blinded, placebo-controlled beta-blockade in heart failure. We present information for a physician advising a patient experiencing an unwanted symptom and suspecting the drug.

methodsWe searched Medline for double-blinded randomized trials of beta-blocker versus placebo in heart failure reporting side-effects. We calculated, per 100 patients reporting the symptom on beta-blockade, how many would have experienced it on placebo: the "proportion of symptoms non-pharmacological".

results28 of the 33 classically-described side-effects are not significantly more common on beta-blockers than placebo. Of the 100 patients developing dizziness on beta-blockers, 81 (95% CI 73-89) would have developed it on placebo. For diarrhoea this proportion is 82/100 (70-95), and hyperglycaemia 83/100 (68-98). For only two side-effects is this under half (i.e. predominantly due to beta-blocker): bradycardia (33/100, CI 21-44) and intermittent claudication (41/100, 2-81). At least 6 so-called side-effects are less common on beta-blocker than placebo, including depression (reduced by 35%, p<0.01) and insomnia (by 27%, p=0.01).

conclusionsClinicians might reconsider whether it is scientifically and ethically correct to warn a patient that a drug might cause them a certain side-effect, when randomized controlled trials show no significant increase, or indeed a significant reduction. A better informed consultation could, in patients taking beta-blockers, alleviate suffering. In patients who might otherwise not take the drug, it might prevent deaths.

Indexed as

Adrenergic beta-AntagonistsDiarrheaDizzinessHeart FailureHumansHyperglycemiaPlacebo EffectPractice Guidelines as TopicRandomized Controlled Trials as TopicAdrenergic beta-AntagonistsBeta-blockersHeart failureSide-effects

Identifiers

PMID23796325
PMCPMC3819624
OpenAlexW2086673416

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-SA
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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.