Abstract Body (Do not enter title and authors here): Background:
Beta-adrenergic blockers are commonly prescribed in the management of peripartum cardiomyopathy (PPCM) during the postpartum period. However, real-world data directly comparing the long-term clinical outcomes of metoprolol versus carvedilol in this population remains limited.

Methods:
Using the TriNetX network, we identified women diagnosed with peripartum cardiomyopathy (PPCM) after delivery. Patients were stratified into two cohorts based on beta-blocker therapy received within 6 months after the diagnosis of PPCM: those treated with metoprolol and those treated with carvedilol. Individuals with a history of heart failure before pregnancy were excluded. Clinical outcomes, including all-cause mortality, all-cause hospitalization, heart failure hospitalization, and proportions of patients with LVEF ≥50%, were evaluated at 1-year and 5-year follow-up intervals. Cohorts were propensity score-matched based on medical comorbidities and medications received.

Results:
Among 1,438 eligible patients, propensity score matching yielded two balanced cohorts of 517 patients each: one treated with metoprolol (mean age 31.5 ± 6.9 years; 41.6% Black; 35.6% White) and the other with carvedilol (mean age 31.5 ± 6.1 years; 41.2% Black; 37.3% White). At 1-year follow-up, the metoprolol group had a significantly lower risk of heart failure hospitalization compared to the carvedilol group (22.4% vs. 28.8%; HR, 0.75; 95% CI, 0.59–0.95; p = 0.02). However, there were no significant differences between the two groups in all-cause mortality (1.9% vs. 1.9%; HR, 1.70; 95% CI, 0.62–4.68; p = 0.30), all-cause hospitalization (55.1% vs. 55.1%; HR, 1.00; 95% CI, 0.85–1.18; p = 0.99), or proportions of patients with LVEF ≥50% (9.1% vs. 7.9%; HR, 1.19; 95% CI, 0.78–1.81; p = 0.42). Similar trends were observed at the 5-year follow-up.

Conclusion:
Among women with PPCM, metoprolol use was associated with a lower risk of heart failure hospitalization compared to carvedilol at both 1-year and 5-year follow-up.