Nearly six million Americans have heart failure, a leading driver of health care costs in the United States.
In a new study, researchers found that the “stiff heart” heart failure variant accounts for about half of all cases and most of the patients take beta-blocker medications despite unclear benefits from their regular use.
The finding links the use of beta-blockers to heart failure hospitalizations among those with this common “stiff heart” heart failure subtype.
The research was conducted by a team at the University of Vermont.
Heart failure occurs when the heart cannot meet the body’s demands.
About half of patients have heart failure characterized by a normal squeeze but impaired relaxation of the heart muscle from a “stiff heart”.
This is also known as heart failure with preserved ejection fraction. The other half of cases are due to a “weak heart” with an abnormal squeeze, also known as heart failure with reduced ejection fraction.
Beta-blockers—medications that lower the heart rate and blood pressure—are strongly recommended in national guidelines for the treatment of “weak heart” heart failure because of their clear benefit.
According to the team, a big problem with ‘stiff heart’ heart failure is that doctors don’t have effective medical therapies.
So, instead, they use the same medications that work for ‘weak heart’ heart failure.
Because beta-blockers save lives in ‘weak heart’ heart failure, doctors assume they are also effective in ‘stiff heart’ heart failure patients—this assumption may be wrong.
In the study, the team analyzed data from the National Institutes of Health-funded TOPCAT (Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist) study.
It was a trial of the medication spironolactone in patients with “stiff heart” heart failure. About four out of five study participants were on beta-blockers.
The researchers found beta-blocker use to be a risk factor for hospitalizations for heart failure among these patients with “stiff heart” heart failure.
Beta-blocker use was linked to a 74% higher risk of heart failure hospitalizations among participants with heart failure and a normal pump function.
The team says in ‘stiff heart’ heart failure, the heart is less able to relax and fill with blood. Beta-blockers appear to increase pressures inside the heart.
This may lead to symptoms like worsening shortness of breath and retention of fluid
Despite their common use, the authors note that beta-blocker use in “stiff heart” heart failure has not been sufficiently studied.
This publication extends their prior work, which found that halting beta-blockers markedly improves levels of the heart failure blood test known as BNP among patients with “stiff heart” heart failure.
The lead author of the study is Timothy Plante, M.D., an assistant professor of medicine at the Larner College of Medicine.
The study is published in JAMA Network Open.
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