Abstract

Heart failure with reduced ejection fraction (HFrEF) continues to be a major health issue worldwide. While β-blockers play a crucial role in treatment, there is ongoing discussion regarding the comparative effectiveness of different agents. This review assessed the relative clinical efficacy of carvedilol, bisoprolol, metoprolol succinate, and bucindolol in individuals with HFrEF, focusing specifically on their effects on overall mortality, hospital admissions for heart failure, left ventricular ejection fraction (LVEF), heart rate, and blood pressure. A systematic review and meta-analysis were conducted following PRISMA guidelines. The databases were searched for studies published in the past ten years. In the end, five eligible studies were identified. Across the five studies (sample sizes ranging from 60 to 6,010, with follow-up periods from 3 months to 4.5 years), carvedilol, bisoprolol, and metoprolol succinate demonstrated comparable effects on mortality and functional outcomes. Pooled analyses revealed no significant differences in mortality (HR 0.97, p = 0.79), LVEF improvement (SMD −3.69, p = 0.32), heart rate reduction (SMD −0.75, p = 0.35), or changes in blood pressure. Bucindolol was not superior to metoprolol overall, although genotype-specific benefits were observed. Recent studies suggested that beta-blockers prescribed for HFrEF demonstrated a uniform effect across the class, indicating that carvedilol, bisoprolol, and metoprolol succinate do not differ significantly in their clinical effectiveness. Consequently, selecting a beta-blocker should take into account the specific characteristics of the patient, their ability to tolerate the medication, and the clinician’s expertise, all aimed at maximizing adherence to guideline-directed medical treatment.

Key words: Heart failure with reduced ejection fraction, β-blockers, carvedilol, bisoprolol, metoprolol succinate, bucindolol, systematic review, meta-analysis