NHLBI-VA study finds no increased survival from beta-blocker for moderate to advanced heart failure

May 30, 2001

A study sponsored by the National Heart, Lung, and Blood Institute (NHLBI) and the Department of Veterans Affairs (VA) found that, overall, the beta-blocker bucindolol did not increase survival for moderate to severe heart failure.

The results also showed racial differences in the drug's effects, although the reasons for these differences are not yet clear. Black heart failure patients received no benefit from bucindolol, while non-black patients treated with the drug lived longer. Non-black patients included whites, Hispanics, Asian/Pacific Islanders, and American Indian/Alaskan Natives. There were no differences by gender in the drug's effects.

The findings of the Beta-Blocker Evaluation of Survival Trial (BEST), which contrast with those of other beta-blocker studies, appear in the May 31 issue of the New England Journal of Medicine.

Other results from BEST are consistent with findings from earlier beta-blocker studies and include: fewer deaths from cardiovascular disease, fewer and shorter hospitalizations for heart failure, and fewer deaths or heart transplants for those treated with bucindolol, compared to the placebo.

"The results from BEST offer physicians valuable added guidance about the use of beta-blockers for heart failure," said NHLBI Director Dr. Claude Lenfant. "Its results also underscore the need to examine gender, racial, and ethnic differences in future studies of cardiovascular disease."

"Based on the large amount of evidence of benefit of beta-blockers from previous studies, beta-blockers should be considered for all heart failure patients at this time, including African American patients. However, further research is needed in this population," said BEST Co-Chair Dr. Eric Eichhorn of the Dallas VA Medical Center.

"In BEST, there was a trend toward longer survival for study participants treated with bucindolol who had less advanced heart failure," said Dr. Michael Domanski, Leader of NHLBI's Clinical Trials Scientific Research Group. "That and the results of earlier studies show how important it is to treat heart failure early, when beta-blockers can make a real difference in survival."

BEST was the first beta-blocker heart failure study to include substantial numbers of black patients and patients with advanced heart failure. It began enrollment in 1995 and was conducted at 90 clinical sites in the United States and Canada. The study enrolled 2,708 participants -- about 33 percent were U.S. veterans; about 22 percent were women; and about 30 percent were from minority groups. The average age of participants was 60 years.

Participants were randomized to receive either bucindolol or a placebo. All patients also received standard heart failure therapy. More than 90 percent of patients were treated with an angiotensin converting enzyme (ACE) inhibitor, a diuretic, and digitalis.

At the time of enrollment, 92 percent of participants had moderately severe heart failure (Class III) and 8 percent had severe heart failure (Class IV). The average left ventricular ejection fraction (a key indicator of how well the heart pumps) was 23 percent. The most common cause of participants' heart failure was coronary artery disease.

BEST had been scheduled to end in June 2000, but was stopped in July 1999 at the recommendation of its Data and Safety Monitoring Board (DSMB). The DSMB based its recommendation upon the totality of evidence available in BEST, as well as on recent findings from other studies, specifically the Cardiac Insufficiency Bisoprolol Study II and the Metoprolol CR/XL Randomized Intervention Trial in Heart Failure.

Follow-up of BEST participants lasted an average of 2 years. Ultimately, 449 (33 percent) of the placebo group and 411 (30 percent) of the bucindolol group died.

"Sometimes you learn more from a neutral trial than a positive one," said Eichhorn, "and this is one of those cases where we learned a tremendous amount. We know that, all in all, other beta-blockers are good for heart failure patients and probably African American heart failure patients as well."

"It's still unclear why bucindolol had such varied effects among these patients," said Domanski. "Other trials had found an overall survival benefit, but they differed from BEST in some key ways. They used different beta blockers, had a less diverse population, with fewer black participants, had a shorter follow-up period, and were done outside the United States, where patient care may have been managed differently. More research is needed so we can understand which patients will benefit from which beta blocker."
To arrange an interview with an NHLBI scientist, contact the NHLBI Communications Office at 301- 496-4236. For an interview with Eichhorn, contact the VA Office of Public Affairs at 212-807-3429.

NHLBI press releases and other materials are available online at www.nhlbi.nih.gov.

NIH/National Heart, Lung and Blood Institute

Related Heart Failure Articles from Brightsurf:

Top Science Tip Sheet on heart failure, heart muscle cells, heart attack and atrial fibrillation results
Newly discovered pathway may have potential for treating heart failure - New research model helps predict heart muscle cells' impact on heart function after injury - New mass spectrometry approach generates libraries of glycans in human heart tissue - Understanding heart damage after heart attack and treatment may provide clues for prevention - Understanding atrial fibrillation's effects on heart cells may help find treatments - New research may lead to therapy for heart failure caused by ICI cancer medication

Machining the heart: New predictor for helping to beat chronic heart failure
Researchers from Kanazawa University have used machine learning to predict which classes of chronic heart failure patients are most likely to experience heart failure death, and which are most likely to develop an arrhythmic death or sudden cardiac death.

Heart attacks, heart failure, stroke: COVID-19's dangerous cardiovascular complications
A new guide from emergency medicine doctors details the potentially deadly cardiovascular complications COVID-19 can cause.

Autoimmunity-associated heart dilation tied to heart-failure risk in type 1 diabetes
In people with type 1 diabetes without known cardiovascular disease, the presence of autoantibodies against heart muscle proteins was associated with cardiac magnetic resonance (CMR) imaging evidence of increased volume of the left ventricle (the heart's main pumping chamber), increased muscle mass, and reduced pumping function (ejection fraction), features that are associated with higher risk of failure in the general population

Transcendental Meditation prevents abnormal enlargement of the heart, reduces chronic heart failure
A randomized controlled study recently published in the Hypertension issue of Ethnicity & Disease found the Transcendental Meditation (TM) technique helps prevent abnormal enlargement of the heart compared to health education (HE) controls.

Beta blocker use identified as hospitalization risk factor in 'stiff heart' heart failure
A new study links the use of beta-blockers to heart failure hospitalizations among those with the common 'stiff heart' heart failure subtype.

Type 2 diabetes may affect heart structure and increase complications and death among heart failure patients of Asian ethnicity
The combination of heart failure and Type 2 diabetes can lead to structural changes in the heart, poorer quality of life and increased risk of death, according to a multi-country study in Asia.

Preventive drug therapy may increase right-sided heart failure risk in patients who receive heart devices
Patients treated preemptively with drugs to reduce the risk of right-sided heart failure after heart device implantation may experience the opposite effect and develop heart failure and post-operative bleeding more often than patients not receiving the drugs.

How the enzyme lipoxygenase drives heart failure after heart attacks
Heart failure after a heart attack is a global epidemic leading to heart failure pathology.

Novel heart pump shows superior outcomes in advanced heart failure
Severely ill patients with advanced heart failure who received a novel heart pump -- the HeartMate 3 left ventricular assist device (LVAD) -- suffered significantly fewer strokes, pump-related blood clots and bleeding episodes after two years, compared with similar patients who received an older, more established pump, according to research presented at the American College of Cardiology's 68th Annual Scientific Session.

Read More: Heart Failure News and Heart Failure Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.