Carvedilol in the treatment of elderly patients with chronic heart failure

Witte, Klaus K.; Clark, Andrew L.

doi:10.2147/cia.s1044

Cited by 4 publications

(1 citation statement)

References 169 publications

(167 reference statements)

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“…Total variability as expressed by SD-IBI is lower in CHF, although not statistically significant. HF as short term variability index is higher in CHF, but this may well be due to the β-blockade (Goldsmith et al, 1997; Witte and Clark, 2008). As a consequence LF/HF is significantly lower in CHF as well.…”

Section: Resultsmentioning

confidence: 99%

Search for HRV-parameters that detect a sympathetic shift in heart failure patients on β-blocker treatment

et al. 2013

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Background: A sympathetic shift in heart rate variability (HRV) from high to lower frequencies may be an early signal of deterioration in a monitored patient. Most chronic heart failure (CHF) patients receive β-blockers. This tends to obscure HRV observation by increasing the fast variations. We tested which HRV parameters would still detect the change into a sympathetic state.Methods and results: β-blocker (Carvedilol®) treated CHF patients underwent a protocol of 10 min supine rest, followed by 10 min active standing. CHF patients (NYHA Class II–IV) n = 15, 10m/5f, mean age 58.4 years (47–72); healthy controls n = 29, 18m/11f, mean age 62.9 years (49–78). Interbeat intervals (IBI) were extracted from the finger blood pressure wave (Nexfin®). Both linear and non-linear HRV analyses were applied that (1) might be able to differentiate patients from healthy controls under resting conditions and (2) detect the change into a sympathetic state in the present short recordings.Linear: mean-IBI, SD-IBI, root mean square of successive differences (rMSSD), pIBI-50 (the proportion of intervals that differs by more than 50 ms from the previous), LF, HF, and LF/HF ratio.Non-linear: Sample entropy (SampEn), Multiscale entropy (MSE), and derived: Multiscale variance (MSV) and Multiscale rMSSD (MSD). In the supine resting situation patients differed from controls by having higher HF and, consequently, lower LF/HF. In addition their longer range (τ = 6–10) MSE was lower as well. The sympathetic shift was, in controls, detected by mean-IBI, rMSSD, pIBI-50, and LF/HF, all going down; in CHF by mean-IBI, rMSSD, pIBI-50, and MSD (τ = 6–10) going down. MSD6–10 introduced here works as a band-pass filter favoring frequencies from 0.02 to 0.1 Hz.Conclusions: In β-blocker treated CHF patients, traditional time domain analysis (mean-IBI, rMSSD, pIBI-50) and MSD6–10 provide the most useful information to detect a condition change.

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Section: Resultsmentioning

confidence: 99%

Search for HRV-parameters that detect a sympathetic shift in heart failure patients on β-blocker treatment

et al. 2013

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Chronische Herzinsuffizienz im Alter

Fischer

Dettmer-Flügge

Thiesemann³

et al. 2011

Z Gerontol Geriat

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The incidence of chronic heart failure rises with increasing age as does the proportion of diastolic dysfunction in comparison to heart failure with reduced systolic ejection fraction. Symptoms are less specific, such as fatigue, which makes a diagnosis more difficult but classification and diagnostic work-up are the same as in younger patients. Regarding therapy there is less data because the typical study population does not include geriatric patients with multimorbidity. Nevertheless ACE inhibitors, angiotensin receptor blockers, aldosterone antagonists, diuretics and digoxin should also be used in geriatric patients considering indications and contraindications and especially interactions with co-morbidities and other prescribed medication on an individual basis. The numbers of patients above the age of 75 years receiving heart surgery is increasing. Current scores often overestimate the risk of an operation even though after individual stratification surgical and interventional procedures can be performed with low risk.

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