Beta-Blockers and One-Year Survival in Heart Failure with Right Ventricular Dysfunction: Evidence from the FRESH Multicentre Cohort

Presenter: C Fauvel

Beta-blockers improve survival in heart failure (HF), but their role in patients with concomitant right ventricular (RV) dysfunction remains uncertain. An analysis of 747 patients from the prospective multicentre FRESH cohort with available RV assessment evaluated the association between beta-blocker use and 1-year all-cause mortality. RV dysfunction, defined echocardiographically, was present in 71% of patients and severe dysfunction in 33%; 107 patients (14%) died within 1 year. After adjustment, beta-blocker prescription was associated with better survival among patients with RV dysfunction (hazard ratio [HR] 0.55; 95% confidence interval [CI] 0.38–0.79; p=0.001). A similar association was observed in severe RV dysfunction (HR 0.56; 95% CI 0.34–0.94; p=0.03), while patients not receiving beta-blockers had worse survival. These findings suggest that RV dysfunction, including severe dysfunction, should not prevent the use of beta-blocker therapy when otherwise indicated in HF.

Carvedilol Versus Metoprolol After Myocardial Infarction in HFpEF: A Propensity-Matched 3-Year Outcomes Analysis

Presenter: T Elimihele

In patients with HFpEF and a recent acute myocardial infarction (MI), the optimal choice of beta-blocker remains uncertain and head-to-head data are sparse. A retrospective TriNetX cohort study compared 3-year cardiovascular outcomes in propensity-matched patients initiated on metoprolol or carvedilol within one month of MI (1,537 per group). All-cause mortality was similar between metoprolol and carvedilol (15.1% vs 15.7%; hazard ratio [HR] 0.94; 95% confidence interval [CI] 0.78–1.13; p=0.511), as were recurrent MI, all-cause hospitalisation, stroke, ventricular tachycardia and cardiac arrest. Acute heart failure occurred less frequently with metoprolol (15.5% vs 18.2%; HR 0.81; 95% CI 0.68–0.97; p=0.019). Beta-blocker selection therefore appeared to have little impact on survival, ischaemic or arrhythmic outcomes, although metoprolol was associated with fewer acute heart failure events, a finding requiring prospective confirmation.

Long-Term Outcomes With Beta-Blockers After Myocardial Infarction According to Left Ventricular Ejection Fraction

Presenter: K Hosseini

Beta-blockers are well established after myocardial infarction (MI) in patients with reduced left ventricular ejection fraction (LVEF), but their role in patients with LVEF above 40% has been less clearly defined. A systematic review and meta-analysis pooled long-term outcomes from 150,182 post-MI patients across 4 randomised controlled trials and 20 cohort studies, with a median follow-up of 3.5 years. Beta-blocker therapy was associated with lower all-cause mortality overall (hazard ratio [HR] 0.82; 95% confidence interval [CI] 0.73–0.93; p<0.001). However, the mortality reduction was limited to patients with LVEF 40–50% (HR 0.70; 95% CI 0.50–0.98) and was not observed in those with LVEF >50% (HR 0.82; 95% CI 0.60–1.20). Secondary cardiovascular outcomes were unaffected. Notably, cohort studies, rather than randomised trials, drove the observed mortality benefit, highlighting the need for further randomised evidence.

Continued Beta-Blocker Therapy Beyond 6 Months After Myocardial Infarction in Patients with LVEF ≥40%: A substudy of BETAMI-DANBLOCK Landmark Trial

Presenter: H Caglar

Long-term beta-blocker therapy after myocardial infarction (MI) remains an important question in patients with left ventricular ejection fraction (LVEF) ≥40%, particularly beyond the early post-MI period. A post hoc landmark analysis of the open-label BETAMI-DANBLOCK trial examined whether continued beta-blocker therapy beyond 6 months influenced subsequent cardiovascular outcomes. The analysis included 5,431 patients who were alive and free of heart failure or recurrent MI at 6 months. Participants were followed for a composite of death, non-fatal MI, non-fatal stroke or cardiovascular hospitalisation. The primary outcome occurred in 639 of 2,720 patients (23.5%) assigned beta-blockers, compared with 698 of 2,711 patients (25.7%) assigned no beta-blocker therapy, corresponding to a 2.3-percentage-point difference (95% confidence interval 0.0–4.5). Continued therapy was therefore associated with fewer subsequent cardiovascular events, with cardiovascular hospitalisation forming an important component of the observed benefit, supporting beta-blocker continuation in clinically stable eligible patients.

Long-term Clinical Outcomes of Beta-blocker Therapy in Elderly Patients with Preserved LV Function After PCI for Acute MI: A Nationwide Registry Analysis

Presenter: J Choe

A nationwide prospective registry examined long-term clinical outcomes with beta-blocker therapy compared with no beta-blocker therapy in 2,566 patients aged ≥70 years without left ventricular systolic dysfunction who underwent percutaneous coronary intervention (PCI) for acute myocardial infarction (MI). Of these, 2,063 received beta-blockers and 503 received no beta-blocker therapy. Over a median follow-up of 998 days, beta-blocker therapy was associated with lower major adverse cardiac events (MACE) compared with no beta-blocker therapy in both the overall cohort (20.9% vs 25.4%; hazard ratio [HR] 0.66; 95% confidence interval [CI] 0.58–0.76, p=0.03) and the propensity-score-matched cohort (20.3% vs 25.8%; HR 0.69; 95% CI 0.61–0.78, p<0.001). All-cause and cardiac mortality were also significantly lower with beta-blocker therapy, while recurrent MI, revascularisation, heart-failure readmission, stroke and stent thrombosis did not differ significantly. Overall, beta-blocker therapy was associated with improved long-term clinical outcomes compared with no beta-blocker therapy in this elderly population.

Beta-Blocker Therapy after Myocardial Infarction in the Contemporary PCI Era: An Updated Meta-Analysis in Preserved or Mildly Reduced Ejection Fraction

Presenter: J Aleman

Beta-blockers have long been recommended after myocardial infarction (MI), largely based on evidence from the pre-reperfusion era. Their role in patients with preserved or mildly reduced left ventricular ejection fraction (LVEF) treated with contemporary percutaneous coronary intervention (PCI) and guideline-directed medical therapy remains under evaluation. An updated meta-analysis of five randomised trials, including 23,524 post-MI patients, compared beta-blocker therapy with no therapy or treatment discontinuation. The primary outcome was all-cause mortality, with cardiovascular death, recurrent MI, heart-failure hospitalisation and stroke assessed as secondary outcomes. Participants were predominantly male, in their early-to-mid-60s, with preserved LVEF and high PCI use. Beta-blocker therapy was associated with a modest but statistically significant reduction in all-cause mortality (risk ratio 0.92; 95% confidence interval 0.85–0.99). However, cardiovascular death, recurrent MI, heart-failure hospitalisation and stroke did not differ significantly, with low heterogeneity across outcomes. Overall, the findings suggest a small survival benefit without clear reductions in specific cardiovascular events, supporting an individualised approach to long-term beta-blocker therapy.

Beta-Blocker Therapy After Acute MI With Preserved or Mildly Reduced Ejection Fraction: A Meta-Analysis of Randomised Trials

Presenter: L D Neira Chunga

Beta-blockers are a cornerstone of secondary prevention after acute myocardial infarction (MI) in patients with reduced left ventricular ejection fraction (LVEF), but their role in those with preserved or mildly reduced LVEF has been examined inconsistently in contemporary trials. A PRISMA-guided meta-analysis of four randomised controlled trials involving 18,504 patients with prior MI and LVEF ≥40% evaluated the association between beta-blocker therapy and major cardiovascular outcomes. The primary composite of all-cause mortality, reinfarction and cardiovascular hospitalisation was not significantly reduced with beta-blockers in the overall population (hazard ratio [HR] 0.90; 95% confidence interval [CI] 0.81–1.01) or among patients with preserved LVEF (HR 0.94; 95% CI 0.87–1.03). A significant reduction was observed in the mildly reduced LVEF subgroup (HR 0.82; 95% CI 0.70–0.97). However, individual outcomes, including mortality and reinfarction, were not significantly reduced overall. The subgroup finding should therefore be interpreted cautiously within the context of an overall neutral effect.

ESC Congress 2026, 28 - 31 Aug, Munich, Germany