Heart failure is a serious medical condition that affects millions of people around the world and is a major cause of hospital admissions.
Despite its name, heart failure does not mean the heart has stopped working. Instead, it means the heart cannot pump enough blood to meet the body’s needs.
When this happens, people may experience shortness of breath, tiredness, swollen legs and ankles, and difficulty doing everyday activities. The condition also places a heavy burden on healthcare systems because many patients need repeated hospital treatment.
Heart failure is not the same for every patient. One common form develops when the heart muscle becomes weak and cannot pump blood effectively. Doctors call this heart failure with reduced ejection fraction. Another form affects about half of all heart failure patients.
In these people, the heart still pumps a normal amount of blood, but the heart muscle has become stiff and cannot relax properly between heartbeats.
Because the heart cannot fill with enough blood before pumping again, the body still receives less oxygen than it needs. This condition is known as heart failure with preserved ejection fraction, or HFpEF, and is sometimes called “stiff heart” heart failure.
Doctors have many proven medicines for people with weak heart failure, including beta-blockers. These medicines slow the heart rate and reduce the amount of work the heart has to do.
They are also widely used to treat high blood pressure, irregular heart rhythms, chest pain, and to protect the heart after a heart attack. For patients with weakened heart muscle, beta-blockers have been shown to improve survival and reduce hospital admissions.
However, whether these medicines help people with stiff heart failure has remained uncertain. Because there have been relatively few successful treatments for HFpEF, doctors have often prescribed beta-blockers even though strong evidence supporting their use has been limited.
Researchers at the University of Vermont wanted to investigate whether this common treatment is truly beneficial for patients with HFpEF. They analyzed information from the TOPCAT study, a large clinical trial funded by the U.S. National Institutes of Health.
Around 80% of the patients included in the study were taking beta-blockers, allowing the researchers to compare outcomes between patients using the medicine and those who were not.
The results raised important concerns. Patients with stiff heart failure who were taking beta-blockers had a 74% higher risk of being hospitalized because of worsening heart failure. This finding suggests that the medicines may not provide the same benefits seen in patients with weak heart failure and could even make symptoms worse in some people.
The researchers believe there may be a reason for this difference. In HFpEF, the heart already has difficulty relaxing and filling with blood.
Beta-blockers may increase pressure inside the heart, making it even harder for blood to fill the chambers. This extra pressure may contribute to fluid build-up, causing swelling, shortness of breath, and other symptoms that often lead to hospital admission.
The findings show that treatments that work well for one form of heart failure cannot automatically be assumed to work for another. Although the symptoms may look similar, the underlying causes are different, meaning patients may need different treatment strategies.
The researchers stress that patients should not stop taking beta-blockers on their own. Many people take these medicines for other important conditions such as irregular heart rhythms, previous heart attacks, or high blood pressure.
Anyone with concerns should discuss them with their doctor, who can consider the person’s overall health and medical history before making any changes.
The study highlights the urgent need for more research into HFpEF, which currently has far fewer proven treatment options than weak heart failure. Scientists hope future studies will identify medicines that specifically target the causes of stiff heart failure and improve quality of life while reducing hospital admissions.
The study was led by Dr. Timothy Plante at the University of Vermont and was published in JAMA Network Open. The findings remind doctors that heart failure is not a single disease and that the best treatment should be matched to the specific type of heart failure each patient has.
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