Long-Term Outcomes: Beta-Blocker Use and Permanent Pacing in Patients With Heart Failure Preserved Ejection Fraction.

BACKGROUND: Heart failure with preserved ejection fraction (HFpEF) confers a large morbidity and mortality burden. There are no therapies for HFpEF with a proven mortality benefit. OBJECTIVES: The purpose of this study was to evaluate the long-term outcomes of pacing and therapy with beta-blockers in patients with HFpEF. METHODS: In this cohort study, patients admitted to one of 11 hospitals in the Northwell Health system over a 3.5-year period with HFpEF were examined. Beta-blockers use and implantation of a permanent pacemaker (PPM) were examined as exposures. The primary outcome was all-cause mortality, and secondary included any hospital readmission or an emergency department visit. RESULTS: Of the 27,848 patients admitted for HFpEF, 22,308 (52.9% female, mean age 73 ± 14 years) were included in the postdischarge analysis (median follow-up 1.5 years [0.6-2.5 years]). Of the 22,308 patients, 44.3% (9,881/22,308) were discharged on a beta-blockers, 2.5% (547/22,308) had a PPM and were not discharged on a beta-blockers, and 1.7% (380/22,308) were maintained on beta-blockers therapy and also had a PPM. The presence of a PPM at the time of discharge was associated with a 32% lower risk of mortality (HR: 0.68; 95% CI: 0.57-0.80), while discharge on a beta-blockers was associated with a 20% lower risk of mortality (HR: 0.80; 95% CI: 0.72-0.89). CONCLUSIONS: The findings of this large retrospective cohort study suggest that use of beta-blockers and permanent pacing are each associated with a lower risk of mortality in patients with HFpEF.