One study Chronic Heart Failure Beta-blockers in heart failure and concomitant atrial fibrillation NICE 2018. All rights reserved. Subject to Notice of rights. ISBN: 978-1-4731-3093-7 was included in the review;181 it is summarised in Table 33 below. See also the study selection flow chart in Appendix C, forest plots in Appendix E, study evidence tables in Appendix F, GRADE tables in Appendix H and excluded studies list in Appendix I. is an individual patient data (IPD) meta-analysis which compiled subgroup data from 10 major beta-blocker mortality trials. The meta-analysis included 4 studies comparing carvedilol and placebo; 2 studies comparing metoprolol and placebo; 2 studies comparing bisoprolol and placebo; 1 study comparing nebivolol and placebo; and 1 study comparing bucindolol and placebo. The committee discussed the studies included within the IPD and agreed that: Bucindolol is not licensed for any indication in the UK (it does not have marketing authorisation), nor is it currently used in practice for HF-REF. This is due to a lack of trial data suggesting prognostic benefit of bucindolol in patients with HF-REF, with respect to all-cause mortality. In addition to this Bucindolol demonstrates pharmacogenetic differences in different ethnicities. Based on this, the committee concluded that results of trials using this beta-blocker should be excluded. Although the form of metoprolol (metroprolol succinate) used in MERIT-HF349 is not available in the UK, an alternative form metoprolol tartrate is available and licensed for use in clinical practice (though it is not licensed for heart failure). The committee agreed that the 2 forms were likely to have a similar overall effect despite difference in pharmacokinetic properties (metoprolol succinate is longer acting and more bioavailable than tartrate). Overall, the committee agreed that studies using this beta-blocker were still considered relevant and should be included. 