Summary of findings for the main comparison. Beta‐blockers compared to placebo or no treatment for chronic heart failure with preserved ejection fraction.
| Beta‐blockers compared to placebo or no treatment for chronic heart failure with preserved ejection fraction | ||||||
| Patient or population: chronic heart failure with preserved ejection fraction Setting: secondary care Intervention: beta‐blockers Comparison: placebo/no treatment | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with placebo/no treatment | Risk with Beta‐blockers | |||||
| Cardiovascular mortality (RR) follow‐up: range 21 months to 3.2 years | Study population | RR 0.78 (0.62 to 0.99) | 1046 (3 RCTs) | ⊕⊕⊝⊝ LOW 1 2 | Three additional studies (ELANDD; SWEDIC; Takeda 2004) reported that no deaths occurred | |
| 173 per 1000 | 135 per 1000 (107 to 171) | |||||
| Heart failure hospitalisation (RR) follow‐up: range 6 months to 3.2 years | Study population | RR 0.73 (0.47 to 1.13) | 449 (4 RCTs) | ⊕⊝⊝⊝ VERY LOW 1 3 4 | Follow‐up unclear for SWEDIC. ELANDD reported that no hospitalisation due to heart failure occurred | |
| 117 per 1000 | 86 per 1000 (55 to 133) | |||||
| Hyperkalaemia | 245 (1 RCT) | ⊕⊝⊝⊝ VERY LOW1 7 | J‐DHF reported one participant in the intervention group (N = 120) experienced hyperkalaemia but did not report on this outcome for the control group. No further data were available from any of the other studies. | |||
| All‐cause mortality (RR) follow‐up: range 21 months to 3.2 years | Study population | RR 0.82 (0.67 to 1.00) | 1105 (4 RCTs) | ⊕⊕⊝⊝ LOW 1 2 | Follow‐up unclear for Adamyan 2010. ELANDD, SWEDIC and Takeda 2004 reported that no deaths occurred | |
| 243 per 1000 | 199 per 1000 (163 to 243) | |||||
| Quality of life (Minnesota) Scale from: 0 to 105 follow‐up: mean 6 months | Mean quality of life (Minnesota) was 24 | MD 1 lower (9.05 lower to 7.05 higher) | ‐ | 93 (1 RCT) | ⊕⊝⊝⊝ VERY LOW 5 6 | Lower = better, 5 point difference considered to be clinically meaningful |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio | ||||||
| GRADE Working Group grades of evidence High certainty: We are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect | ||||||
1 Downgraded by one level due to unclear selection bias in most studies.
2 Downgraded by one level due to concerns about the smaller study being more precise than the larger study.
3 Downgraded by one level due to large variation in size of effect.
4 Downgraded by two levels due to few events and wide CI.
5 Downgraded by two levels due to very small sample size.
6 Suspected publication bias; this is a patient‐relevant outcome that is not reported in most studies.
7 Downgraded by two levels due to incomplete reporting.