Comparison of nebivolol, carvedilol, and bisoprolol for adverse clinical outcomes among patients with heart failure-a real-world nationwide investigation.

The authors report a retrospective cohort study based on a national dataset that explores the association between the prescription of three beta-blockers (BB) and a diagnosis of heart failure (HF) readmission, cardiovascular (CV) death, and all-cause death. Patients with HF who received nebivolol, carvedilol, and bisoprolol between 2016 and 2020 were identified. Univariate and multivariate Cox proportional hazard regression analyses were employed to assess and examine the crude and adjusted hazard ratio of the outcomes associated with the three BBs, demographics, comorbidities, and concomitant medications. We further performed Cox proportional hazards regression analyses for the three BBs stratified by age. A total of 109,466 BB patients including 85,166 bisoprolol patients, 19,741 carvedilol patients, 4559 nebivolol patients, and 109,466 non-BB patients were enrolled in our study. Both carvedilol and bisoprolol cohorts had a higher risk of readmission for HF than the non-BB cohort (carvedilol: adjusted HR = 1.13, 95% CI = 1.10-1.15; bisoprolol: adjusted HR = 1.17, 95% CI = 1.16-1.19). Nebivolol cohorts had a lower risk of readmission for HF than the non-BB cohort (adjusted HR = 0.78, 95% CI = 0.74-0.83). There were higher risks of CV (carvedilol: adjusted HR = 1.31, 95% CI = 1.26-1.36; bisoprolol: adjusted HR = 1.17, 95% CI = 1.14-1.2) and all-cause (carvedilol: adjusted HR = 1.26, 95% CI = 1.23-1.29; bisoprolol: adjusted HR = 1.18, 95% CI = 1.17-1.20) deaths in the carvedilol and bisoprolol cohorts in contrast to the non-BB nebivolol cohort. Nebivolol cohorts had a lower risk of CV deaths and all-cause deaths than the non-BB cohort (adjusted HR = 0.77, 95% CI = 0.69-0.85; adjusted HR = 0.78, 95% CI = 0.73-0.83). The authors concluded that the use of nebivolol was associated with better outcomes in patients with HF.