Objective  To systematically evaluate the efficacy of β-blocker in pediatric patients with congestive heart failure and congenital heart disease, and to provide evidence for clinician.

Methods  Before-and-after self-control study and randomized controlled trials were retrieved from PubMed, EMbase, the Cochrane Library, CNKI, WanFang, VIP databases, and the search time was from the establishment of the database to October 31, 2023. All outcomes included left ventricular ejection fraction (LVEF), left ventricular fraction shortening, LVFS), left ventricular end-diastolic dimension (LVDD), Left ventricular end-systolic dimension (LVSD), N-terminal proB brain natriuretic peptide (NT-proBNP), heart rate, blood pressure and cardiac function improvement.

Results  A total of 20 trials involving 1 068 children with heart failure (dilated cardiomyopathy and endocardial fibroelastosis were included. Meta-analysis results showed that the addition of β-blockers (metoprolol succinate, bisoprolol and carvedilol) on the basis of conventional drug therapy for heart failure had significant effects on LVEF[MD=13.06, 95%CI(11.67, 14.45), P<0.001], LVFS[MD=6.96, 95%CI(6.54, 7.37), P<0.001], LVDD[MD=-6.43, 95%CI(-7.58, -5.28), P<0.001] and LVSD[MD=-8.30, 95%CI(-8.83, -7.76), P<0.001] were significantly improved. In addition, blood pressure, heart rate, NT-proBNP and cardiac function could also be improved.

Conclusion  The combination regimen of β-blockers on the basis of conventional drug therapy for heart failure can improve cardiac function and symptoms of heart failure in children with congestive heart failure. Therefore, it is recommended that β-blockers should be actively used in the conventional treatment regimen for children with congestive heart failure.

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