ESC Congress 2026 Abstract · Oct 26, 2026

The range of left ventricular ejection fraction associated with survival benefit from beta-blockers

By Choi JH, Choi KH, Lee JM et al.

Background: The clinical benefit of beta-blockers across the spectrum of left ventricular ejection fraction (LVEF) remains uncertain, particularly in patients with mildly reduced systolic function. Purpose: We evaluated the association between baseline beta-blocker use and long-term survival across the continuous range of LVEF. Methods: We included 27,705 patients (mean age 64 years, 76% male) from KAMIR, a nationwide AMI registry, between 2012 and 2020. Primary outcome was 3-year all-cause mortality. Confounding was addressed using inverse probability of treatment weighting (IPTW). Outcomes were analyzed using weighted Royston–Parmar flexible parametric survival models that allowed for time-varying treatment effects of beta-blocker use. The LVEF range associated with benefit of beta-blockers and number needed to treatment (NNT) were derived from absolute risk difference between groups. Results: Overall, patients with beta-blockers (N=21,675) had higher 3-year survival than those without beta-blockers (N=6,030) (mortality 7.2% versus 9.4%; NNT = 45). The survival benefit diminished progressively with increasing LVEF, and was no longer statistically significant at LVEF ≥ 50%, though without evidence of harm. NNT was lowest in lower LVEF and increased with higher LVEF. Within the range of significant benefit of beta-blockers, NNT were 5, 10, 27, and 102 for for LVEF of 20%, 30%, 40%, and 50%, respectively. Conclusions: The survival benefit of beta-blockers attenuated continuously with increasing LVEF, and was evident in patients with LVEF < 50% but not LVEF ≥ 50%. Our results support an individualized approach to beta-blocker therapy guided by LVEF rather than fixed categorical thresholds.Survival benefit of beta-blocker across LV EF

doi.org/10.1093/eurheartj/ehag785.4112 Open access Interventions