Related Experiment Videos
Beta-blocker therapy in patients with heart failure in the urban setting: moving beyond clinical trials
Jerry D Estep1, Sameer K Mehta, Fatema Uddin
1Heart Failure Research Unit, Dallas, Tex, USA.
Insights
Most heart failure patients can tolerate beta-blockers (BBL). Lower systolic blood pressure and higher diuretic doses may indicate when to refer patients to cardiologists for BBL initiation.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Beta-blockers (BBL) offer known benefits for heart failure but are underutilized, particularly in primary care.
- Identifying patient characteristics to guide BBL initiation is crucial for primary care physicians.
- Assessing BBL tolerability in real-world clinical practice is essential.
Purpose of the Study:
- To identify patient characteristics that help primary care physicians decide on BBL initiation for heart failure.
- To determine the tolerability of BBL in a clinical heart failure setting.
Main Methods:
- Retrospective chart review of 551 patients with systolic dysfunction referred to a heart failure clinic.
- Stratification of BBL response into favorable (improved ejection fraction), unfavorable (decompensated heart failure), or neither.
- Assessment of BBL tolerability based on the need for permanent discontinuation.
Main Results:
- 66% of the 551 patients tolerated BBL.
- Lower systolic blood pressure and higher diuretic doses were associated with unfavorable responses (decompensated heart failure) compared to favorable responses (improved ejection fraction).
Conclusions:
- The majority of heart failure patients in this urban hospital setting can tolerate BBL.
- Measurable factors like systolic blood pressure and diuretic dose can aid primary care physicians in patient triage for cardiologist referral for BBL initiation.
Background:
Despite their known benefits, beta-blockers (BBL) are not yet widely prescribed for heart failure, especially in the primary care setting. We wanted to identify patient characteristics that could guide primary care physicians in deciding whether they or a cardiologist should initiate BBL. A second objective was to determine the tolerability of BBL in clinical practice.
Methods:
A retrospective chart review was conducted on a consecutive series of 551 patients with systolic dysfunction referred to a heart failure clinic in an urban public hospital. Patient responses to BBL were stratified into three categories: favorable (improvement of left ventricular ejection fraction by serial echocardiography), unfavorable (development of decompensated heart failure), or neither. Tolerability of BBL was assessed by the need to permanently discontinue BBL.
Results:
Of 551 patients, 363 (66%) tolerated BBL. Among patients who had BBL initiated in the clinic, 48 had a favorable response, 34 had an unfavorable response, and 57 had neither a favorable or unfavorable response, as defined. A lower systolic blood pressure and higher diuretic dose were associated with development of decompensated heart failure as compared to improvement of ejection fraction.
Conclusions:
A majority of patients with heart failure in an urban public hospital can tolerate BBL. Easily measurable characteristics such as lower systolic blood pressure and higher diuretic dose may assist primary care physicians in triaging patients for referral to cardiologists for beta-blocker initiation.
Related Concept Videos
01:22Heart Failure Drugs: β-Blockers
01:30Heart Failure V: Medical Management
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
01:22Heart Failure VI: Adjunct Therapies
01:31Adrenergic Antagonists: ɑ and β-Receptor Blockers
01:27Adrenergic Antagonists: Pharmacological Actions of β-Receptor Blockers