Highlights of ESC HF 2021 - Which Beta Blocker in HFmrEF?

<p><strong>What is the evidence and which beta-blocker should a patient with HFmrEF receive?</strong></p> <p><br></p> <p>Till Copernicus trial ejection fraction were used to define outcome of a trial, but now this clinical parameter is used to group individuals with Heart Failure that will yield different outcome to a given treatment.</p> <p>In 2016, ESC Heart Failure guidelines classified and defined HF with reduced ejection fraction, HF with preserved ejection fraction, and HF with mid-range ejection fraction.</p> <p>Studies like CHARM, I PRESERVE &amp; TOPCAT were disappointment as they showed results with ARNI or RAAS inhibitors close to placebo in patients with HF with preserved ejection fraction, only PRAGON-HF trial with Sacubitril/Valsartan showed a positive response.</p> <p>In post hoc analysis of CHARM study, Candesartan treatment showed effectiveness in HF with reserved and mid-range ejection fraction and not in preserved ejection fraction.</p> <p>If we consider retrospective studies with Beta Blockers, in SENIORS trial among all type of HF patient, individuals with mid-range ejection fraction were also fairly represented, and the outcomes showed less mortality &amp; CV hospitalization in patients with LVEF &gt;35%. When further analysis were made with LVEF in quintiles, it was revealed that those in &gt;40-60% had significant mortality and hospitality benefit compared to other quintiles.</p> <p>A meta-analysis of Beta Blockers in Heart Failure showed significant survival from all-cause mortality &amp; CV mortality in patients with LVEF 40-49% with sinus rhythm.</p> <p>Thus it was concluded that post ESC HF guidelines we have more knowledge of outcomes of HF with mid-range ejection fraction, more retrospective evidence, the best evidence of outcome is with Beta Blockers and with Sacubitril + Valsartan from studies with particular data on mid-range Heart failure.</p> <p>Thus we can treat mid-range HF effectively.</p> <p><br></p> <p><strong>Disclaimer:</strong> Lupin makes no representation or warranty o