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USE OF Β-ADRENOBLOCKERS IN PATIENTS WITH HEART FAILURE AND CONCOMITANT THYROID PATHOLOGY (LITERATURE REVIEW AND OWN

Iu Rudyk1, S Pyvovar1

  • 1State Institution "National Institute of Therapy named after L.T. Malaya NAMS of Ukraine", Kharkiv, Ukraine.

Georgian Medical News
|November 1, 2022
PubMed

Insights

Beta-blocker use in heart failure with thyroid issues requires careful dosing. Bisoprolol may not reduce rehospitalizations in low triiodothyronine syndrome and can worsen outcomes if doses exceed 5 mg.

Area of Science:

  • Cardiology
  • Endocrinology
  • Pharmacology

Background:

  • Heart failure with reduced ejection fraction (HFrEF) is often complicated by thyroid dysfunction.
  • Beta-blockers are standard therapy for HFrEF, but their role in patients with thyroid issues is less clear.
  • Low triiodothyronine syndrome is a common finding in heart failure patients.

Purpose of the Study:

  • To review existing literature on beta-blocker use in HFrEF with thyroid pathology.
  • To present original research on bisoprolol's efficacy in HFrEF patients with low triiodothyronine syndrome.
  • To determine optimal dosing strategies for bisoprolol in this patient population.

Main Methods:

  • Systematic review of literature on beta-blockers in HFrEF and thyroid disease.
  • Prospective study involving HFrEF patients with and without low triiodothyronine syndrome treated with bisoprolol.
  • Analysis of rehospitalization rates, cardiac function, and thyroid hormone levels.

Main Results:

  • Bisoprolol did not decrease rehospitalization rates in HFrEF patients with low triiodothyronine syndrome.
  • In patients without low triiodothyronine syndrome, higher bisoprolol doses were associated with lower rehospitalization rates compared to lower doses.
  • In patients with low triiodothyronine syndrome, exceeding 5 mg of bisoprolol increased rehospitalization risk, altered thyroid hormone levels, and worsened cardiac dimensions.

Conclusions:

  • Current beta-blocker guidelines for HFrEF may apply to patients with thyroid dysfunction, with specific dose limitations.
  • In HFrEF patients with low triiodothyronine syndrome, bisoprolol titration should not exceed 5 mg and should be gradual (over 63 days).
  • Further pharmacogenetic studies are warranted to elucidate the complex interactions between beta-blockers, heart failure, and thyroid pathology.

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