Long-Term Outcomes - Beta-Blocker Use and Permanent Pacing in Patients With Heart Failure Preserved Ejection Fraction

Sep 29, 2026

Uploaded by Theodore

Heart failure with preserved ejection fraction (HFpEF) carries substantial morbidity and mortality, yet no therapies have shown a proven mortality benefit. This cohort study evaluated long-term outcomes of permanent pacing and beta-blocker therapy in HFpEF patients. Among 27,848 admissions, 22,308 were analyzed. Discharge on beta-blockers and presence of a permanent pacemaker at discharge were each associated with lower all-cause mortality in adjusted analyses.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages11

Reading Time28 min

AccessFree to download

Abstract

Background

Objectives

Methods

Results

Conclusions

Methods

Study Design and Patient Population

J A C C : A D V A N C E S V O L . 5 , N O . 1 , 2 0 2 6 © 2 0 2 6 T H E A U T H O R S . P U B L I S H E D BY E L S E V I E R O N B E H A L F O F T H E A M E R I C A N C O L L E G E O F C A R D I O L O GY F O U N D A T I O N . T H I S I S A N O P E N A C C E S S A R T I C L E U N D E RT H E C C B Y-N C-N D L I C E N S E ( [h t t p : / / c r e a t i v e c o m m o n s . o r g / l i c e n s e s / b y-n c-n d / 4 . 0 /](h t t p : / / c r e a t i v e c o m m o n s . o r g / l i c e n s e s / b y-n c-n d / 4 . 0 /) ) . ORIGINAL RESEARCH Long-Term Outcomes Beta-Blocker Use and Permanent Pacing in Patients With Heart Failure Preserved Ejection Fraction James K. Gabriels, MD,a Kristie Coleman, MPH, RN,a Joanna Fishbein, MPH,b Gregory Cunn, MD,a Alexandra Bekiaridou, MD,a Dimitrios Varrias, MD,a Nikhil Sharma, MD,a Moein Mokhtari, MD,a Riya George, MD,a Christina Brennan, MD,a Amir Gandomi, PHD,a Sirish Vullaganti, MD, MSC,a Laurence M. Epstein, MD,a Stavros E. Mountantonakis, MD, MBAa ABSTRACT BACKGROUND Heart failure with preserved ejection fraction (HFpEF) confers a large morbidity and mortality burden. There are no therapies for HFpEF with a proven mortality benefit. OBJECTIVES The purpose of this study was to evaluate the long-term outcomes of pacing and therapy with betablockers in patients with HFpEF. METHODS In this cohort study, patients admitted to one of 11 hospitals in the Northwell Health system over a 3 .5-year period with HFpEF were examined. Beta-blockers use and implantation of a permanent pacemaker (PPM) were examined as exposures. The primary outcome was all-cause mortality, and secondary included any hospital readmission or an emergency department visit. RESULTS Of the 27,848 patients admitted for HFpEF, 22,308 (52.9% female, mean age 73 ± 14 years) were included in the postdischarge analysis (median follow-up 1.5 years [0.6-2.5 years]) . Of the 22,308 patients, 44.3%(9,881/22,308) were discharged on a beta-blockers, 2.5%(547/22,308) had a PPM and were not discharged on a betablockers, and 1.7%(380/22,308) were maintained on beta-blockers therapy and also had a PPM. The presence of a PPM at the time of discharge was associated with a 32% lower risk of mortality (HR: 0.68; 95% CI: 0.57-0.80), while discharge on a beta-blockers was associated with a 20% lower risk of mortality (HR: 0.80; 95% CI: 0.72-0.89) . CONCLUSIONS The findings of this large retrospective cohort study suggest that use of beta-blockers and permanent pacing are each associated with a lower risk of mortality in patients with HFpEF. (JACC Adv. 2026;5:102425) © 2026 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation. This is an open access article under the CC BY-NC-ND license ([http://creativecommons.org/licenses/by-nc-nd/4.0/](http://creativecommons.org/licenses/by-nc-nd/4.0/)). H eart failure (HF) is one of the most com mon causes for hospital admissions in the United States, accounting for approximately 6.5 million hospital days annually.1 Over half of HF hospitalizations are due to heart failure with preserved ejection fraction (HFpEF), and the incidence of HFpEF is increasing.2 ,3 The estimated 5-year rate of mortality after a HF hospitalization inpatients with HFpEF is 75% .4 ,5 Unfortunately, thereis limited pharmacologic therapy with demonstrated From the aNorthwell Cardiovascular Institute, Center for Arrhythmias, New Hyde Park, New York, USA; and the bOffice of Academic Affairs, New Hyde Park, New York, USA. The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the Author Center. Manuscript received July 3, 2025; revised manuscript received October 29, 2025, accepted November 14, 2025. ISSN 2772-963X [https://doi.org/10.1016/j.jacadv.2025.102425](https://doi.org/10.

FAQs

What question does the study address about HFpEF?

It evaluates whether permanent pacing and beta-blocker therapy are associated with improved long-term outcomes, especially all-cause mortality, in patients with HFpEF.

How were outcomes measured in the cohort study?

All-cause mortality was the primary outcome, with secondary outcomes including any hospital readmission or an emergency department visit.

What were the main findings regarding mortality?

Having a permanent pacemaker at discharge was associated with a lower risk of mortality (HR 0.68), and discharge on beta-blockers was also associated with a lower risk (HR 0.80).

Sep 29, 2026

Uploaded by Theodore