Atenolol pra ICC com FE baixa, serve?

Beta-bloqueadores e ICC: Efeito de Classe?

“Tudo muda, exceto a mudança”

Uma metanálise publicada no British Medical Journal com 21 trials, conduzida de acordo com a  Cochrane Collaboration, sugere que os efeitos dos beta bloqueadores possam ser mais um efeito de classe, não havendo uma grande superioridade individual. Claro que há limitações e deve ser interpretado com cautela, mas segue comentário abaixo:

Veja a íntegra open access em:

RESEARCH Benefits of β blockers in patients with heart failure and reduced ejection fraction: network meta-analysis BMJ 2013;346:f55

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“February 2, 2013

ST LOUIS (MD Consult) - Different beta-blockers have similar benefits for patients with heart failure and reduced ejection fraction, concludes a meta-analysis in the February 2, 2012, British Medical Journal.

A systematic review identified 21 randomized trials evaluating the efficacy of beta-blockers in patients with heart failure and reduced ejection fraction. Drugs assessed were atenolol, bisoprolol, bucindolol, carvedilol, metoprolol, and nebivolol.

In a network meta-analysis, outcomes were compared between individual beta-blockers and between beta-blockers and other active or inactive treatments. The main outcome of interest was all-cause mortality at the longest available follow-up. The lead author was Saurav Chatterjee of Maimonides Medical Center, New York.

At a median follow-up of 12 months, beta-blockers were associated with significantly reduced mortality: odds ratio 0.69 compared to placebo/standard therapy. For carvedilol, the absolute reduction in mortality was 6.6%, with a number needed to treat of 15 to prevent 1 death.

Direct comparison of individual beta-blockers found no significant differences in overall mortality or in sudden cardiac death, death from pump failure, or drug discontinuation. All drugs were associated with significant and similar increases in left ventricular ejection fraction.

Because of differences in adrenergic selectivity and effects on peripheral circulation, there is debate as to the best choice of individual beta-blockers for patients with heart failure. No previous systematic reviews have compared the efficacy of individual beta-blockers in preventing clinically relevant endpoints.

This network meta-analysis suggests a class effect of beta-blockers for treatment of heart failure with reduced ejection fraction. Available randomized trial data do not support the efficacy of any individual drug compared to the others. The investigators conclude, "More head to head comparisons of individual β blockers are needed to definitively answer the question of whether one agent is clearly superior."

BMJ. 2013;346:f55.”