Heart failure affects millions of people and is a major cause of hospital stays in the United States.
It happens when the heart cannot move enough blood around the body, which can cause shortness of breath, tiredness, and swelling in the legs or other parts of the body.
Heart failure is not one single disease. In some people, the heart muscle becomes weak and cannot squeeze strongly enough, while in others the heart can still pump normally but becomes too stiff to relax and fill properly between beats.
The second form is called heart failure with preserved ejection fraction, or HFpEF. It is sometimes described as “stiff heart” heart failure, and it accounts for a large share of heart failure cases, especially among older adults.
Treating HFpEF has been difficult because it is not the same as heart failure caused by a weak heart. Medicines that clearly help people with reduced pumping strength do not always provide the same benefits for people whose main problem is poor relaxation and filling.
A study led by researchers at the University of Vermont examined the use of beta-blockers in people with HFpEF. Beta-blockers are common medicines that slow the heart rate and can lower blood pressure, and they are also used to treat abnormal heart rhythms and protect some people after a heart attack.
These drugs can be life-saving for certain patients with heart failure in which the heart’s pumping ability is reduced. However, there has been much less evidence showing that they help people with HFpEF.
The researchers looked at information from TOPCAT, a large clinical trial involving people with HFpEF. Around 80% of the patients included in the analysis were taking beta-blockers, allowing the team to compare their outcomes with those of patients who were not using the drugs.
The results raised an important concern. Patients taking beta-blockers were reported to have a 74% higher risk of being hospitalized for heart failure than those who were not taking them.
One possible explanation is that slowing the heart may not always help a stiff heart. Because the heart already has difficulty relaxing and filling, beta-blockers could increase pressure inside the heart in some patients, which may contribute to fluid buildup, breathing problems, and worsening symptoms.
The findings do not mean that everyone with HFpEF should stop taking beta-blockers. Many patients take these medicines for other important reasons, such as high blood pressure, a previous heart attack, or certain heart rhythm problems, and suddenly stopping a beta-blocker can also be dangerous.
Instead, the study highlights why treatments need to match the specific type of heart failure a person has. A medicine that has strong evidence for one form of heart failure may not have the same effect in another form.
The researchers, led by Dr. Timothy Plante, said more studies are needed to understand when beta-blockers are useful or harmful in people with HFpEF. The research was published in JAMA Network Open and adds to growing efforts to find safer and more effective treatments for this common form of heart failure.
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