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Differential Impact of Metoprolol Formulations on Heart Failure Outcomes: A Multicenter Study

Year: 2025

Type: article

Abstract: Background Despite widespread use of metoprolol formulations in heart failure (HF), direct comparative evidence of their clinical outcomes remains limited. Methods In this retrospective cohort study using the TriNetX Research Network (2010-2024), we compared outcomes between metoprolol succinate and tartrate in HFrEF (EF ≤40%) and HFmrEF (EF 41-49%) patients. After propensity score matching (761 pairs for HFrEF, 732 pairs for HFmrEF), we evaluated a primary composite outcome of hospitalizations and all-cause mortality, and secondary outcomes of individual components over one year follow-up. Results Baseline characteristics were well-balanced between cohorts in both HF populations. For the primary composite outcome, both HFrEF and HFmrEF patients receiving succinate formulation demonstrated significantly better event-free survival compared to tartrate (HFrEF: 64.12% vs 51.22%, log-rank p<0.001; HFmrEF: 67.57% vs 56.04%, log-rank p<0.001). Secondary analysis revealed these benefits were driven by improvements in both hospitalizations and all-cause mortality. Conclusions Metoprolol succinate was associated with significantly improved event-free survival compared to tartrate in Kaplan-Meier analyses for both HFrEF and HFmrEF populations, despite modest differences in crude event rates. These findings suggest that formulation-specific pharmacokinetics influence long-term outcomes in heart failure management, supporting current guidelines favoring succinate over tartrate.

Source: Journal of Cardiac Failure - Intersections

DOI: 10.1016/j.yjcafi.2025.10.010