Suboptimal Dosing of β-Blockers in Chronic Heart Failure: A Missed Opportunity?

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Abstrakt

Tytuł:: Suboptimal Dosing of β-Blockers in Chronic Heart Failure: A Missed Opportunity?
Autorzy:: McGinlay M
Straw S
Byrom-Goulthorp R
Relton SD
Gierula J
Cubbon RM
Kearney MT
Witte KK
Źródło:: The Journal of cardiovascular nursing [J Cardiovasc Nurs] 2022 Nov-Dec 01; Vol. 37 (6), pp. 589-594. Date of Electronic Publication: 2021 Jul 28.
Typ publikacji:: Journal Article; Research Support, U.S. Gov't, Non-P.H.S.
Język:: English
Imprint Name(s):: Publication: 2003- : Hagerstown, MD : Lippincott Williams & Wilkins
Original Publication: [Frederick, MD : Aspen Publishers, c1986-
MeSH Terms:: Heart Failure*
Humans ; Bisoprolol/therapeutic use ; Stroke Volume/physiology ; Prospective Studies ; Adrenergic beta-Antagonists/therapeutic use ; Chronic Disease
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Grant Information:: CH/13/1/30086 United Kingdom BHF_ British Heart Foundation; FS/12/80/29821 United Kingdom BHF_ British Heart Foundation; FS/18/44/33792 United Kingdom BHF_ British Heart Foundation; FS/CRTF/20/24071 United Kingdom BHF_ British Heart Foundation
Substance Nomenclature:: Y41JS2NL6U (Bisoprolol)
0 (Adrenergic beta-Antagonists)
Entry Date(s):: Date Created: 20210729 Date Completed: 20221024 Latest Revision: 20230924
Update Code:: 20240105
PubMed Central ID:: PMC7613698
DOI:: 10.1097/JCN.0000000000000847
PMID:: 34321430
: Czasopismo naukowe

Background: The evidence base for the benefits of β-blockers in heart failure with reduced ejection fraction (HFrEF) suggests that higher doses are associated with better outcomes.
Objectives: The aim of this study was to report the proportion of patients receiving optimized doses of β-blockers, outcomes, and factors associated with suboptimal dosing.
Methods: This was a prospective cohort study of 390 patients with HFrEF undergoing clinical and echocardiography assessment at baseline and at 1 year.
Results: Two hundred thirty-seven patients (61%) were receiving optimized doses (≥5-mg/d bisoprolol equivalent), 72 (18%) could not be up-titrated (because of heart rate < 60 beats/min or systolic blood pressure <100 mm Hg), and the remaining 81 (21%) should have been. Survival was similarly reduced in those who could not and should have been receiving 5 mg/d or greater, and patient factors did not explain the failure to attain optimized dosing.
Conclusions: Many patients with HFrEF are not receiving optimal dosing of β-blockers, and in around half, there was no clear contraindication in terms of heart rate or blood pressure.
Competing Interests: K.K.W. has received speakers' fees and honoraria from Medtronic, Cardiac Dimensions, Novartis, Abbott, BMS, Pfizer, and Bayer and has received an unconditional research grant from Medtronic. None of the other authors have conflicts of interest to disclose.
(Copyright © 2021 The Authors. Published by Wolters Kluwer Health, Inc.)

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