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

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.