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 unclear, which may prompt 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 (RCTs), quasi-randomized studies, and non-randomized studies. Outcomes included mortality, major adverse cardiovascular (CV) events, HF hospitalizations, function, quality of life, and 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 were conflicting. Conclusions Evidence on beta-blocker discontinuation in HFpEF or HFimpEF is limited and comes from heterogeneous populations/subgroups. Future RCTs examining long-term, clinical outcomes can clarify uncertainty around the benefits/harms of beta-blocker discontinuation.