Beta-Blocker Discontinuation in Heart Failure with Preserved or Improved Ejection Fraction: A Systematic Review.

Authors

Wade Thompson, Nima Alaeiilkhchi, Lisa M McCarthy, William McDonald, Raha Eskandari, Yanrong Maggie Yang, Douglas M Salzwedel, Parag Goyal

Published in

Journal of cardiac failure. Aug 13, 2026. Epub Aug 13, 2026.

Abstract

Beta-blockers are commonly used among patients with heart failure and preserved or improved ejection fraction (HFpEF or HFimpEF). The benefits of beta-blockers in these populations are not clear, which may raise consideration of discontinuation. We conducted a systematic review on the effects of beta-blocker discontinuation versus continuation among adults ≥18 years with HFpEF or HFimpEF.
We searched MEDLINE, Embase, Cochrane CENTRAL, Google Scholar, Epistemonikos, and reference lists of eligible studies from inception to September 11, 2025. Eligible studies were randomized controlled trials (RCT), quasi-randomized studies, and non-randomized studies. Outcomes were mortality, major adverse cardiovascular events (MACE), HF hospitalizations, function, quality of life, as well as cardiovascular (CV) physiological and echocardiographic parameters. We conducted a narrative synthesis.
We screened 4103 titles/abstracts, and 4 studies were eligible (1 RCT in HFpEF, 1 RCT in HFimpEF, and 2 cohort studies in HFimpEF). In HFpEF, beta-blocker discontinuation improved functional capacity and quality-of-life at 2 weeks compared with continuation with no clear effect on cognition, echocardiographic parameters or CV biomarkers. Long-term effects of beta-blocker discontinuation, and the effect on important clinical outcomes were unclear for HFpEF. In HFimpEF, available evidence suggests beta-blocker discontinuation might not lead to significant changes in CV physiology parameters, biomarkers, echocardiographic parameters, or clinical status compared with continuation, but findings on important long-term clinical outcomes was conflicting.
Evidence on beta-blocker discontinuation in HFpEF or HFimpEF is limited and comes from heterogenous populations/subgroups. Future RCTs examining long-term, clinical outcomes can clarify uncertainty around the benefits/harms of beta-blocker discontinuation.

PMID:
42595251
Bibliographic data and abstract were imported from PubMed on 14 Aug 2026.

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