β-Blocker Use and Health Status Among Patients With Heart Failure With Preserved Ejection Fraction

Importance β-Blockers are widely used for patients with heart failure with preserved ejection fraction (HFpEF). However, their association with health status among this population remains unknown. Objective To evaluate the association of β-blocker use with health status among patients with HFpEF. Design, Setting, and Participants This cohort study was a secondary analysis of the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist randomized clinical trial, which enrolled 3445 patients with HFpEF (left ventricular ejection fraction [LVEF] ≥45%) to receive spironolactone or placebo. We excluded 1678 patients from Georgia or Russia and 41 with missing baseline Kansas City Cardiomyopathy Questionnaire overall summary score (KCCQ-OS) or β-blocker data, resulting in an analytic cohort of 1726 patients enrolled between August 10, 2006, and January 31, 2012. Statistical analysis was performed from July to November 2024. Exposure β-Blocker use. Main Outcomes and Measures Heath status was assessed with the KCCQ-OS, a heart failure–specific health status patient-reported outcome measure. The cross-sectional association of β-blocker use and baseline KCCQ-OS was assessed using multivariable linear regression, adjusted for demographic and clinical factors, and testing the interaction of β-blocker × LVEF. A second model examined changes in KCCQ-OS from baseline to 4 months and tested the interaction between β-blocker use and spironolactone to examine whether β-blockers were associated with modification of the health status benefit of spironolactone. Results Among 1726 patients with HFpEF (mean [SD] age, 71.6 [9.7] years; 862 women [49.9%]; mean [SD] LVEF, 58.1% [7.7%]), 1356 (78.6%) were receiving β-blockers at baseline. β-Blocker use was not significantly associated with concurrent KCCQ-OS (mean difference, −1.1 points [95% CI, −3.7 to 1.4 points]; P = .38). This association did not significantly differ by LVEF, although patients with LVEF of 65% or more who used β-blockers had a numerically lower KCCQ-OS score (mean difference, −6.1 points [95% CI, −12.3 to 0.0 points]) compared with LVEF of 55% to 64% (mean difference, 0.0 points [95% CI, −3.9 to 3.8 points) and LVEF of 45% to 54% (mean difference, −0.2 points [95% CI, −4.3 to 3.8 points]) ( P = .21 for interaction). In the longitudinal model, β-blockers were not associated with modification of the health status benefits of spironolactone at 4 months (mean difference, 2.9 points [95% CI, −1.0 to 4.9 points] with β-blockers vs 0.1 [95% CI, −3.7 to 3.9 points] without; P = .20 for interaction). Conclusions and Relevance In this cohort study of patients with HFpEF, β-blocker use was not associated with better or worse baseline health status or the modification of the health status benefits of spironolactone at 4 months. Further research is needed to better understand the association of β-blockers with health status among patients with HFpEF.