Beta-Blocker Discontinuation in Heart Failure with Preserved or Improved Ejection Fraction: A Systematic Review
In brief
Stopping beta-blockers improves function and quality of life in HFpEF
A systematic review of four studies found that withdrawing beta-blockers in patients with heart failure with preserved ejection fraction led to better functional capacity and higher quality-of-life scores within two weeks, without clear changes in heart imaging or biomarkers. Long-term effects and impact on mortality remain uncertain, highlighting the need for larger trials.
- Journal
- Journal of cardiac failure (Q1)
- Published
- 13 August 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Wade Thompson, Nima Alaeiilkhchi, Lisa M McCarthy, William McDonald, Raha Eskandari, Yanrong Maggie Yang, et al.
- PMID
- 42595251
- DOI
- 10.1016/j.cardfail.2026.07.029
Why clinicians should know about it
- Picked for Biochemistry (medical) (top studies of the week, 16 August 2026): Beta‑blocker discontinuation trial, no metabolic assay data
Abstract
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.