Evidence map›Paper›PMID 29040525›Full record

SynthesisEuropean heart journal2018

Beta-blockers for heart failure with reduced, mid-range, and preserved ejection fraction: an individual patient-level analysis of double-blind randomized trials.

John G F Cleland, Karina V Bunting, Marcus D Flather, Douglas G Altman, Jane Holmes, Andrew J S Coats, Luis Manzano, John J V McMurray, Frank Ruschitzka, Dirk J van Veldhuisen and 12 more

Open access · bronzeAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in European heart journal, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 292 papers, 11 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
292citing papers in PubMed, 11 pooled it
32.8field-weighted citation impact, top 1% 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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

292 citing papers in PubMed, 11 syntheses or guidelines pooled it, 630 citations in OpenAlex.

  1. The Impact of β-Blocker Therapy on Peak VOAmerican journal of cardiovascular drugs : drugs, devices, and other interventions · 2026
    Pooled it
  2. Pooled it
  3. Pooled it
  4. Pooled it
  5. Pooled it
  6. Pooled it
  7. Pooled it
  8. Pooled it
  9. Pooled it
  10. Pooled it
  11. Pooled it
  12. Trial
  13. Trial
  14. Trial
  15. Trial
  16. Trial
  17. Trial
  18. Trial
  19. Trial
  20. Trial

232 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

22 authors at 15 institutions in 9 countries.

John G F ClelandRobertson Institute of Biostatistics and Clinical Trials Unit, University of Glasgow, University Avenue, Glasgow G12 8QQ, UK.
Karina V BuntingInstitute of Cardiovascular Sciences, University of Birmingham, Vincent Drive, Birmingham B15?2TT, UK.
Marcus D FlatherNorwich Medical School, Faculty of Medicine and Health Science, University of East Anglia, Norwich NR4 7TJ, UK.
Douglas G AltmanCentre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford OX1 2JD, UK.
Jane HolmesCentre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford OX1 2JD, UK.
Andrew J S CoatsSan Raffaele Pisana Scientific Institute, Via della Pisana, 235, 00163 Rome, Italy.
Luis ManzanoInternal Medicine Department, Hospital Universitario Ramón y Cajal, Universidad de Alcalá (IRYCIS), Plaza de San Diego, 28801 Alcalá de Henares, Madrid, Spain.
John J V McMurrayInstitute of Cardiovascular and Medical Sciences, University of Glasgow, University Avenue, Glasgow G12 8QQ, UK.
Frank RuschitzkaKlinik für Kardiologie, UniversitätsSpital Zürich, Universitätstrasse 8, 8006 Zürich, Switzerland.
Dirk J van VeldhuisenDepartment of Cardiology, University Medical Centre Groningen, University of Groningen, PO box 30.001 9700 RB Groningen, The Netherlands.
Thomas G von LuederDepartment of Cardiology, Oslo University Hospital, PO Box 4950 Nydalen N-0424 Oslo, Norway.
Michael BöhmKardiologie, Angiologie und internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Kirrberger Str. 100, 66421 Homburg/Saar, Germany.
Bert AnderssonDepartment of Cardiology, Sahlgrenska University Hospital and Gothenburg University, Blå stråket 5, 413 45 Gothenburg, Sweden.
John KjekshusRikshospitalet University Hospital and Faculty of Medicine, University of Oslo, Problemveien 7, 0315 Oslo, Norway.
Milton PackerBaylor Heart and Vascular Institute, Baylor University Medical Center, 621 Hall St, Dallas TX 75226, USA.
Alan S RigbyHull York Medical School, Faculty of Health Sciences, University of Hull, Kingston-upon-Hull, HU6 7RX, UK.
Giuseppe RosanoCardiovascular and Cell Science Institute, St George's University of London, SW17 0RE, UK.
Hans WedelHealth Metrics, Sahlgrenska Academy, University of Gothenburg, Box 100, S-405 30 Gothenburg, Sweden.
Åke HjalmarsonDepartment of Cardiology, Sahlgrenska University Hospital and Gothenburg University, Blå stråket 5, 413 45 Gothenburg, Sweden.
John WikstrandWallenberg Laboratory for Cardiovascular Research, Sahlgrenska Academy, Gothenburg University, Bruna Stråket 16, 413 45 Gothenburg, Sweden.
Dipak KotechaInstitute of Cardiovascular Sciences, University of Birmingham, Vincent Drive, Birmingham B15 2TT, UK.
Beta-blockers in Heart Failure Collaborative Group
Sahlgrenska University Hospital · SEUniversity of Birmingham · GBUniversity of Glasgow · GBUniversity of Gothenburg · SEBaylor University Medical Center · USIRCCS Ospedale San Raffaele · ITNuffield Orthopaedic Centre · GBOslo University Hospital · NOUniversidad de Alcalá · ESUniversitätsklinikum des Saarlandes · DEUniversity Medical Center Groningen · NLUniversity of East Anglia · GBUniversity of Hull · GBUniversity of Oslo · NOUniversity of Oxford · GB

Funding

Cancer Research UK 16895Department of Health CDF-2015-08-074
6 · The paper itself

Abstract

Aims: Recent guidelines recommend that patients with heart failure and left ventricular ejection fraction (LVEF) 40-49% should be managed similar to LVEF ≥ 50%. We investigated the effect of beta-blockers according to LVEF in double-blind, randomized, placebo-controlled trials. Methods and results: Individual patient data meta-analysis of 11 trials, stratified by baseline LVEF and heart rhythm (Clinicaltrials.gov: NCT0083244; PROSPERO: CRD42014010012). Primary outcomes were all-cause mortality and cardiovascular death over 1.3 years median follow-up, with an intention-to-treat analysis. For 14 262 patients in sinus rhythm, median LVEF was 27% (interquartile range 21-33%), including 575 patients with LVEF 40-49% and 244 ≥ 50%. Beta-blockers reduced all-cause and cardiovascular mortality compared to placebo in sinus rhythm, an effect that was consistent across LVEF strata, except for those in the small subgroup with LVEF ≥ 50%. For LVEF 40-49%, death occurred in 21/292 [7.2%] randomized to beta-blockers compared to 35/283 [12.4%] with placebo; adjusted hazard ratio (HR) 0.59 [95% confidence interval (CI) 0.34-1.03]. Cardiovascular death occurred in 13/292 [4.5%] with beta-blockers and 26/283 [9.2%] with placebo; adjusted HR 0.48 (95% CI 0.24-0.97). Over a median of 1.0 years following randomization (n = 4601), LVEF increased with beta-blockers in all groups in sinus rhythm except LVEF ≥50%. For patients in atrial fibrillation at baseline (n = 3050), beta-blockers increased LVEF when < 50% at baseline, but did not improve prognosis. Conclusion: Beta-blockers improve LVEF and prognosis for patients with heart failure in sinus rhythm with a reduced LVEF. The data are most robust for LVEF < 40%, but similar benefit was observed in the subgroup of patients with LVEF 40-49%.

Indexed as

Heart FailureAdrenergic beta-AntagonistsAgedAtrial FibrillationDouble-Blind MethodFemaleHumansMaleMiddle AgedPlacebosRandomized Controlled Trials as TopicStroke VolumeAdrenergic beta-AntagonistsPlacebosAtrial fibrillationBeta-blockersEjection fractionHeart failureMortalitySinus rhythm

Identifiers

PMID29040525
PMCPMC5837435
OpenAlexW2761111693

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

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.