INCIDENCE OF ADVERSE EVENTS RESULTING FROM BETA-BLOCKER TITRATION IN PATIENTS WITH HEART FAILURE

Beta blockers are an essential part of the treatment and management of heart failure. Unfortunately, due to adverse events, it is not possible to titrate the medication to the recommended dose in all patients according to the guidelines. The role of adverse events in the treatment of bisoprolol, carvedilol, and metoprolol in the Georgian population when titration is not possible was studied.

A study was conducted to evaluate the side effects observed in low-dose and medium-dose beta blockers in Georgia. Initially 300 patients with reduced ejection fraction met the inclusion criteria, but only 223 developed side effects to beta blockers and were incorporated into the study. Patients were divided into 3 groups, depending on which beta blocker they were taking - bisoprolol, carvedilol, or metoprolol. The data was evaluated using descriptive analysis and two-tailed independent t-tests.

Out of the 223 patients that developed side-effects to beta blockers 64.1% had bradycardia, 54.2% had hypotension, 32.7% had dyspnea, 41.3% had fatigue, and 38.1% had dizziness. Episodes of bradycardia and hypotension prevailed in patients receiving bisoprolol, while the incidence of adverse events was more evenly distributed in the carvedilol and metoprolol groups. It is also worth noting that patients receiving bisoprolol more often experienced only 1 side effect compared to the carvedilol and metoprolol groups, where the simultaneous manifestation of multiple symptoms increased with increasing dose.

The inability to use beta-blockers at their maximum recommended dose is a major problem in Georgia. Only 25.7% of patients were able to take the recommended dose of the medication. The study revealed the most frequently detected side effects that prevent medication titration, rarely occur alone, and in most cases the patient presents with a mixture of several side effects. Specific symptoms were noted to be associated with specific medications more often than with others, for example: patients on bisoprolol were noted to develop bradycardia more frequently than patients on carvedilol. Since titration to a higher dose of the medication is directly proportional to the increase in life-expectancy, it is preferable, if there is a choice, to prescribe treatment with the beta-blocker which the patient will be able to tolerate better and which has a lower risk of side effects.