OBJECTIVES: Previous reports suggest that betablockers appear non-beneficial after surgical aortic valve replacement (SAVR). This study aims to clarify the associations between betablockers and long-term outcome after SAVR.

METHODS: All patients with isolated SAVR due to aortic stenosis in Sweden between 2006 and 2020, alive at six months after surgery, were included. Patients were identified in the SWEDEHEART registry and records were merged with data from three other mandatory national registries. Association between dispensed betablockers and MACE (all-cause mortality, myocardial infarction, stroke) was analyzed using Cox proportional hazards models, with time-updated data on medication and adjusted for age, sex, and comorbidities at baseline.

RESULTS: In total, 11849 patients were included (median follow-up 5.4 years [range 0-13.5]). Betablockers were prescribed to 79.7% of patients at baseline, decreasing to 62.2% after 5 years. Continuing treatment was associated with higher risk of MACE (adjusted hazard ratio 1.14 [95% confidence interval 1.05-1.23]). The association was consistent over subgroups based on age, sex, and comorbidities except atrial fibrillation (HR 1.05 [95% CI 0.93-1.19]). A sensitivity analysis including time-updated data on comorbidites attenuated the difference between the groups (HR 1.04 [95% CI 0.95-1.14, p = 0.33]).

CONCLUSIONS: Treatment with betablockers did not appear to be associated with inferior long-term outcome after SAVR, when adjusting for new concomitant diseases. Thus, it is likely that it is the underlying cardiac diseases that are associated with MACE rather than betablocker treatment.