{"id":10893,"date":"2011-08-16T09:36:50","date_gmt":"2011-08-16T13:36:50","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?post_type=news&#038;p=10893"},"modified":"2011-08-16T09:36:50","modified_gmt":"2011-08-16T13:36:50","slug":"meta-analysis-beta-blockers-may-be-less-effective-in-u-s-than-elsewhere","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2011\/08\/16\/meta-analysis-beta-blockers-may-be-less-effective-in-u-s-than-elsewhere\/","title":{"rendered":"Meta-analysis: Beta-Blockers May Be Less Effective in U.S. Than Elsewhere"},"content":{"rendered":"<p>Beta-blockers may not be as effective in the U.S. as in the rest of the world, according to <a href=\"http:\/\/content.onlinejacc.org\/cgi\/content\/abstract\/58\/9\/915\">a meta-analysis published in the <em>Journal of the American College of Cardiology<\/em><\/a>. Christopher O&#8217;Connor and colleagues analyzed data on patients enrolled in the MERIT-HF, COPERNICUS, CIBIS-II (which did not enroll U.S. patients) and BEST trials. Some 4,200 U.S. patients were included.<\/p>\n<p>The mortality benefit of beta-blockade was smaller in the U.S. than in the rest of the world, and the beneficial effect was not significant in the U.S. By contrast, the effect remained significant elsewhere:<\/p>\n<p>Relative risk for mortality with beta-blockers:<\/p>\n<ul>\n<li>U.S.: 0.92 (CI 0.82-1.02, p&lt;0.106)<\/li>\n<li>Rest of world: 0.64 (CI 0.56-0.72, p&lt;0.0001)<\/li>\n<\/ul>\n<p>The authors speculate about a number of different explanations for the finding, but conclude that &#8220;whatever the cause, geographic differences are reported frequently in the literature, and these findings support the need to re-evaluate the conduct, methodology, and analysis procedures of international trials to ensure that the generalizability of study findings can accurately be determined.&#8221;<\/p>\n<p>In <a href=\"http:\/\/content.onlinejacc.org\/cgi\/content\/full\/58\/9\/923\">an accompanying editorial<\/a>, Barry Massie points out that 81% of the deaths in the U.S. occurred in the BEST trial, and that &#8220;the deaths in the latter 2 trials are evenly split, with wide confidence intervals that do not exclude a meaningful mortality benefit of <span style=\"text-decoration: underline;\">&gt;<\/span>20% in the U.S. patients.&#8221;<\/p>\n<p>Although Massie argues that the findings of the meta-analysis should not be completely dismissed, he thinks that &#8220;based on the totality of data with beta-blockers and their experience, few heart failure physicians would withhold carvedilol or metoprolol from their patients.&#8221;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Beta-blockers may not be as effective in the U.S. as in the rest of the world, according to a meta-analysis published in the Journal of the American College of Cardiology. Christopher O&#8217;Connor and colleagues analyzed data on patients enrolled in the MERIT-HF, COPERNICUS, CIBIS-II (which did not enroll U.S. patients) and BEST trials. Some 4,200 [&hellip;]<\/p>\n","protected":false},"author":196,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[14],"tags":[312,947,948],"class_list":["post-10893","post","type-post","status-publish","format-standard","hentry","category-heart-failure","tag-beta-blockers","tag-carvedilol","tag-metoprolol"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/10893","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/196"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=10893"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/10893\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=10893"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=10893"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=10893"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}