Summary of findings 1. 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: patients with chronic heart failure with preserved ejection fraction Setting: secondary care Intervention: beta‐blockers Comparison: placebo or no treatment | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with placebo or 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 | 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 follow‐up: mean 3.2 years |
245 (1 RCT) | ⊕⊝⊝⊝ VERY LOW1 6 | 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 (MLHFQ): from 0 to 105 follow‐up: mean 6 months | Mean quality of life (MLHFQ) was 24 | MD 1 lower (9.05 lower to 7.05 higher) | ‐ | 93 (1 RCT) | ⊕⊝⊝⊝ VERY LOW 4 5 | 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; MD: Mean difference; MLHFQ: Minnesota Living with Heart Failure Questionnaire; RCT: Randomised controlled trial; 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 | ||||||
1Downgraded by one level due to study limitations (unclear selection bias in most studies).
2Downgraded by one level due to imprecision (concerns about the smaller study being more precise than the larger study).
3Downgraded by two levels due to imprecision (few events and wide CI).
4Downgraded by two levels due to imprecision (very small sample size).
5Downgraded by one level due to suspected publication bias (this is a patient‐relevant outcome that is not reported in most studies).
6Downgraded by two levels due to suspected publication bias (incomplete reporting).