In Heart Failure, Beta-Blockers Boost Survival Advantage For Women

“Women with heart failure should be battling the disease with the same weapons as men,” says Jalal K. Ghali, M.D., director of clinical research at Cardiac Centers of Louisiana in Shreveport, who led the study that looked at the effect of beta-blockers on the combined endpoints of mortality and hospitalization. Women who took the beta-blocker metoprolol CR/XL lived longer and were hospitalized less often than women who were not on the drugs.

Pooled data from the three largest heart failure studies of beta-blockers found increased survival in women taking beta-blockers. “The individual studies may not have had enough subjects to detect a survival benefit, but the combined data show a benefit from these drugs. Based on our results, clinicians should feel very comfortable prescribing beta-blockers to women, and not think twice about gender-related differences in their effects,” Ghali says.

Researchers analyzed the effect of metoprolol CR/XL in women in the Metoprolol CR/XL Randomized Intervention Trial in Heart Failure (MERIT-HF), the largest database of women taking beta-blockers to treat heart failure.

They analyzed the effect of the drug on a subgroup of women with severe heart failure. The researchers also pooled data from two other large studies to analyze overall survival benefits of the three beta-blockers for women: the Cardiac Insufficiency Bisoprolol Study (CIBIS-II), looking at the beta-blocker bisoprolol, and the Carvedilol Prospective Randomized Cumulative Survival Study Group (COPERNICUS), which studied carvedilol. MERIT-HF had a total of 3,991 patients with heart failure and LVEF of less than 40 percent. The trial showed a 34 percent reduction in deaths.

Ghali’s team looked more closely at the 898 women in MERIT-HF, focusing on total death and hospitalization and found a 21 percent overall reduction in death and hospitalization per patient per year in the metoprolol CR/XL group compared to the placebo group. There was a 19 percent reduction in all-cause hospitalization in women, a 29 percent drop in cardiovascular-related hospitalization and 42 percent fewer hospitalizations for heart failure.

Combined data with the CIBIS II and COPERNICUS studies showed that in women, the three beta-blockers – metoprolol CR/XL, bisoprolol and carvedilol – increased total survival similar to that of men.

Co-authors are Ileana L. Piña, M.D.; Stephen S. Gottlieb, M.D.; Prakash C. Deedwania, M.D.; and John C. Wikstrand, M.D, Ph.D.