Heart failure affects millions of people and is a major reason older adults are admitted to hospital.
Despite its name, heart failure does not mean the heart has completely stopped working. It means the heart cannot pump or fill well enough to meet the body’s needs.
Common symptoms include shortness of breath, unusual tiredness and swelling in the legs or abdomen. Fluid can also build up in the lungs, making breathing difficult. However, heart failure is not a single condition, and different forms can require different treatments.
In one major type, the heart muscle becomes weak and cannot squeeze strongly enough. Doctors call this heart failure with reduced ejection fraction. Ejection fraction describes how much blood the heart’s main pumping chamber pushes out with each beat.
Another common form is heart failure with preserved ejection fraction, or HFpEF. In these patients, the heart may still squeeze out a normal percentage of blood, but the muscle is often too stiff to relax and fill properly. This is sometimes described in simpler terms as “stiff heart” heart failure.
A study led by researchers at the University of Vermont raised questions about using beta-blocker medicines in people with this second type of heart failure. Beta-blockers are widely used for high blood pressure, abnormal heart rhythms and some other heart conditions. They can also be lifesaving for many patients whose hearts have weakened pumping ability.
Beta-blockers generally slow the heart rate and reduce the effects of stress hormones such as adrenaline. This can lower the heart’s workload and provide important protection in certain cardiovascular diseases. But a treatment that helps one type of heart failure does not automatically help another.
The researchers examined information from TOPCAT, a large clinical trial funded by the National Institutes of Health. TOPCAT studied people with heart failure whose ejection fraction was preserved. Around 80% of the participants included in the analysis were taking beta-blockers.
The researchers found that beta-blocker use was associated with a 74% higher risk of hospitalization for heart failure. The study was led by Dr. Timothy Plante and was published in *JAMA Network Open*. The result raised concern because these medicines were being used by a large majority of the patients studied.
One possible explanation involves the way a stiff heart fills with blood. In HFpEF, the heart may need enough time and the right conditions to relax between beats. Changes caused by beta-blockers could potentially increase pressure inside the heart in some patients, contributing to fluid buildup and breathing problems.
However, the study does not prove that beta-blockers directly caused the additional hospitalizations. The researchers analyzed existing clinical trial data rather than randomly assigning patients specifically to receive or avoid beta-blockers. People taking the drugs may have had other heart problems that also increased their risk.
This distinction is important. Beta-blockers are prescribed for many good reasons, including certain abnormal heart rhythms, previous heart attacks and other conditions that can occur alongside HFpEF. A patient may therefore still need a beta-blocker even if the medicine does not directly treat the underlying stiff-heart problem.
Patients should not stop taking beta-blockers because of this study without speaking with their doctor. Suddenly stopping some heart medicines can cause the heart rate or blood pressure to rise and may create serious problems. Instead, the findings support reviewing why each medicine is being used and whether it remains appropriate.
Treatment for HFpEF has also changed as researchers have learned more about the condition.
It is now understood as a complex disease that can be linked to aging, obesity, diabetes, high blood pressure, kidney disease and other health problems. Modern care often focuses on treating these related conditions as well as reducing fluid buildup and preventing hospitalization.
The University of Vermont study highlights a larger lesson about heart failure research. Two patients can have similar symptoms but very different problems inside the heart. Treatments with strong evidence for weakened pumping may not provide the same benefits when pumping strength is preserved.
The reported 74% increase is important enough to justify further research, but it should be interpreted as an association rather than a final answer.
Carefully designed trials would be needed to determine whether reducing or avoiding beta-blockers improves outcomes in selected HFpEF patients. Researchers would also need to identify which patients still benefit because of other medical conditions.
For people living with HFpEF, the study reinforces the value of individualized care. Doctors need to consider the type of heart failure, other heart conditions and the reason behind every prescription.
As scientists learn more about stiff-heart failure, treatment may become increasingly tailored rather than relying on medicines simply because they work well in other forms of heart disease.
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