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.