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Beta-blockers in chronic heart failure as recorded in the FAR NHL registr


Authors: K. Lábr 1;  J. Špinar 2;  J. Pařenica 2;  L. Špinarová 1;  F. Málek 3;  M. Špinarová 1;  O. Ludka 2;  J. Jarkovský 4 ;  K. Benešová 4;  R. Lábrová 2
Authors place of work: I. interní kardioangiologická klinika LF MU a FN u sv. Anny v Brně 1;  Interní kardiologická klinika LF MU a FN Brno 2;  Kardiocentrum, Nemocnice Na Homolce, Praha 3;  Institut bio­statistiky a analýz, LF a PřF MU, Brno 4
Published in the journal: Kardiol Rev Int Med 2017, 19(1): 68-72

Summary

Background:
Beta-blockers (BB) and angiotensin-converting-enzyme inhibitors (ACE-I) or angiotensin receptor blockers (ARB) are part of the first-line treatment of heart failure with reduced ejection fraction (HFrEF), leading to decreased morbidity and mortality. Methods: The data were collected from the Pharmacology and l Neurohumoral Activation Registry (FAR NHL). Patients with left ventricle ejection fraction (LV EF) under 50% who were stable for at least one month were included.

Results:
A total of 1,100 patients were included, median age was 65 years, 80.8% were male. Of all patients, 20% received low dose (LD), 57% medium dose (MD) and 17% high dose (HD). Of these, 6.2% of patients were not treated with BBs at all. The higher the blood pressure (BP; LD 124/77; MD 129/80; HD 132/82 mm Hg, p < 0.001), LV EF (LD 29.5; MD 30.5; HD 32.0%; p = 0.003), creatinine clearance rate (CrCl; LD 78.7; MD 87.8; HD 91.1 ml/min; p = 0.001) or body weight (LD 83.2; MD 88.7; HD 93.5 kg; p < 0.001) was, the higher the dose of BB they received. The lower the NT-proBNP level was, the higher the dose of BB they received (LD 767; MD 456; HD 314 pg/ml; p < 0.001). There was no difference in prescription of BB depending on the presence of atrial fibrillation (AF). Patients with AF were more often treated with digoxin or a combination of digoxin and BB than patients without AF (p < 0.001).

Summary:
Nearly 94% of HFrEF patients received BB, but only 17% received the target dose of BB. Ninety-nine % of patients treated with BB received one of the drugs recommended by the ESC Guidelines. The more severe the illness was, as expressed by lower BP, CrCl, LV EF, body weight and higher NT-proBNP, the lower the dose of BB the patients received and tolerated.

Keywords:
adrenergic beta-antagonists – heart failure – pro-brain natriuretic peptide – blood pressure – drug therapy – left ventricle ejection fraction – creatinine clearance


Zdroje

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7. McMurray JJ, Adamopoulos S, Anker SD et al. ESC Guidelines for the dia­gnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Dia­gnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J 2012; 33(14):1787–1847. doi: 10.1093/ eurheartj/ ehs104.

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Štítky
Paediatric cardiology Internal medicine Cardiac surgery Cardiology
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