Abstract 14695: Higher Beta Blocker Dose versus Lower Heart Rate in HFrEF With Atrial Fibrillation

Background: The relative importance of the dose of beta blocker used as compared to the decrease in heart rate(HR) achieved remains unclear for patients with heart failure with reduced ejection fraction (HFrEF) in atrial fibrillation (AF). Methods: The VA’s databases were queried to identify all patients diagnosed with HFrEF from 2007 to 2015 in AF. Then 12,232 patients on low dose beta blocker (carvedilol or metoprolol succinate) were matched with as many patients on high dose beta-blocker using propensity score matching. The impact of beta blocker dose and HR was assessed on overall mortality using Cox proportional hazard model on the matched sample and adjusting for patient characteristics. Results: In patients with AF, after dividing average HR into separate quartiles and adjusting for patient characteristics, high dose of beta blocker was associated with lower overall mortality as compared to a low dose of beta blocker (HR: 0.77, 95% CI: 0.74-0.80, p<0.01) independent of the HR achieved. The results ...