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2026, Vol: 10, Issue: 7
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Review Article
Online Published: 30 Jun 2026
 


Comparative effectiveness of beta-blockers in heart failure with reduced ejection fraction: a systematic review and meta-analysis

Jana Khald Allaboon, Lamees Naji Alsaleh, Khaled Amer Alsoairy, Mada Ali Aljohani, Bassam Mohammed Asiri, Alaa Mastour Alghamdi, Dalia Salem Almosleh, Lena Abdullah Mirkhan, Reem Abdullah Alkhathami.


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


 
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How to Cite this Article
Pubmed Style

Allaboon JK, Alsaleh LN, Alsoairy KA, Aljohani MA, Asiri BM, Alghamdi AM, Almosleh DS, Mirkhan LA, Alkhathami RA. Comparative effectiveness of beta-blockers in heart failure with reduced ejection fraction: a systematic review and meta-analysis. IJMDC. Online First: 30 Jun, 2026. doi:10.24911/IJMDC.51-1774724559

Web Style

Allaboon JK, Alsaleh LN, Alsoairy KA, Aljohani MA, Asiri BM, Alghamdi AM, Almosleh DS, Mirkhan LA, Alkhathami RA. Comparative effectiveness of beta-blockers in heart failure with reduced ejection fraction: a systematic review and meta-analysis. https://www.ijmdc.com/?mno=315529 [Access: June 30, 2026]. doi:10.24911/IJMDC.51-1774724559

AMA (American Medical Association) Style

Allaboon JK, Alsaleh LN, Alsoairy KA, Aljohani MA, Asiri BM, Alghamdi AM, Almosleh DS, Mirkhan LA, Alkhathami RA. Comparative effectiveness of beta-blockers in heart failure with reduced ejection fraction: a systematic review and meta-analysis. IJMDC. Online First: 30 Jun, 2026. doi:10.24911/IJMDC.51-1774724559


Vancouver/ICMJE Style

Allaboon JK, Alsaleh LN, Alsoairy KA, Aljohani MA, Asiri BM, Alghamdi AM, Almosleh DS, Mirkhan LA, Alkhathami RA. Comparative effectiveness of beta-blockers in heart failure with reduced ejection fraction: a systematic review and meta-analysis. IJMDC, [cited June 30, 2026]; Online First: 30 Jun, 2026. doi:10.24911/IJMDC.51-1774724559


Harvard Style

Allaboon, J. K., Alsaleh, . L. N., Alsoairy, . K. A., Aljohani, . M. A., Asiri, . B. M., Alghamdi, . A. M., Almosleh, . D. S., Mirkhan, . L. A. & Alkhathami, . R. A. (2026) Comparative effectiveness of beta-blockers in heart failure with reduced ejection fraction: a systematic review and meta-analysis. IJMDC, Online First: 30 Jun, 2026. doi:10.24911/IJMDC.51-1774724559


Turabian Style

Allaboon, Jana Khald, Lamees Naji Alsaleh, Khaled Amer Alsoairy, Mada Ali Aljohani, Bassam Mohammed Asiri, Alaa Mastour Alghamdi, Dalia Salem Almosleh, Lena Abdullah Mirkhan, and Reem Abdullah Alkhathami. 2026. Comparative effectiveness of beta-blockers in heart failure with reduced ejection fraction: a systematic review and meta-analysis. International Journal of Medicine in Developing Countries, Online First: 30 Jun, 2026. doi:10.24911/IJMDC.51-1774724559


Chicago Style

Allaboon, Jana Khald, Lamees Naji Alsaleh, Khaled Amer Alsoairy, Mada Ali Aljohani, Bassam Mohammed Asiri, Alaa Mastour Alghamdi, Dalia Salem Almosleh, Lena Abdullah Mirkhan, and Reem Abdullah Alkhathami. "Comparative effectiveness of beta-blockers in heart failure with reduced ejection fraction: a systematic review and meta-analysis." International Journal of Medicine in Developing Countries Online First: 30 Jun, 2026. doi:10.24911/IJMDC.51-1774724559


MLA (The Modern Language Association) Style

Allaboon, Jana Khald, Lamees Naji Alsaleh, Khaled Amer Alsoairy, Mada Ali Aljohani, Bassam Mohammed Asiri, Alaa Mastour Alghamdi, Dalia Salem Almosleh, Lena Abdullah Mirkhan, and Reem Abdullah Alkhathami. "Comparative effectiveness of beta-blockers in heart failure with reduced ejection fraction: a systematic review and meta-analysis." International Journal of Medicine in Developing Countries Online First: 30 Jun, 2026. Web. 30 Jun 2026 doi:10.24911/IJMDC.51-1774724559


APA (American Psychological Association) Style

Allaboon, J. K., Alsaleh, . L. N., Alsoairy, . K. A., Aljohani, . M. A., Asiri, . B. M., Alghamdi, . A. M., Almosleh, . D. S., Mirkhan, . L. A. & Alkhathami, . R. A. (2026) Comparative effectiveness of beta-blockers in heart failure with reduced ejection fraction: a systematic review and meta-analysis. International Journal of Medicine in Developing Countries, Online First: 30 Jun, 2026. doi:10.24911/IJMDC.51-1774724559




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