Indications for β‐Blocker Prescriptions in Heart Failure with Preserved Ejection Fraction

Abstract

OBJECTIVES To better understand indications for β‐blocker (BB) prescriptions among older adults hospitalized with heart failure with preserved ejection fraction (HFpEF). DESIGN/SETTING Retrospective observational study of hospitalizations derived from the geographically diverse Reasons for Geographic and Racial Differences in Stroke cohort. PARTICIPANTS We examined Medicare beneficiaries aged 65 years or older with an expert‐adjudicated hospitalization for HFpEF (left ventricular ejection fraction = 50% or greater). MEASUREMENTS Discharge medications and indications for BBs were abstracted from medical records. RESULTS Of 306 hospitalizations for HFpEF, BBs were prescribed at discharge in 68%. Among hospitalizations resulting in BB prescriptions, 60% had a compelling indication for BB—44% had arrhythmias, and 29% had myocardial infarction (MI) history. Among the 40% with neither indication, 57% had coronary artery disease (CAD) without MI and 38% had hypertension alone (without arrhythmia, MI, or CAD), both clinical scenarios with little supportive evidence of benefit of BBs. Among hospitalizations resulting in BB prescription at discharge, 69% had geriatric conditions (functional limitation, cognitive impairment, hypoalbuminemia, or history of falls). There were no significant differences in the prevalence of geriatric conditions between hospitalizations of individuals with compelling indications for BBs and hospitalizations of individuals with noncompelling indications. CONCLUSIONS BBs are commonly prescribed following a hospitalization for HFpEF, even in the absence of compelling indications. This occurs even for hospitalizations of individuals with geriatric conditions, a subpopulation who may be at elevated risk for experiencing harm from BBs.

Intraventricular pressure gradients change during the development of left ventricular hypertrophy: Effect of salvianolic acid B and beta-blocker

“…In addition, the association of betablocker use with heart failure and hospitalization increases the need for another medication to be identified, which may act as a replacement and overcome some of these disadvantages. 3,4 Salvianolic acid B (Sal-B), a water-soluble extract from the traditional Chinese medicine Radix Salviae Miltiorrhizae, is a potent antioxidant and antiinflammatory drug with cardioprotective properties in vitro. 5 Preclinical studies revealed that Sal-B could alleviate ischemia-induced myocardial injury and modulate angiogenesis in vivo.…”

Complex and Potentially Harmful Medication Patterns in Heart Failure with Preserved Ejection Fraction

“…45 Although beta-blockers may be used to treat comorbid conditions commonly observed in heart failure with preserved ejection fraction such as atrial fibrillation and coronary artery disease, a recent study from REGARDS showed that almost half of adults hospitalized with heart failure with preserved ejection fraction do not have a compelling indication for a beta-blocker. 46 Taken together, our findings identify beta-blockers as a medication that merits reconsideration for routine use in heart failure with preserved ejection fraction. With a rising rate and degree of multimorbidity (>50% of older adults with heart failure now contend with at least 5 other chronic medical conditions), pharmacologic therapeutic competition is an underrecognized but important issue in heart failure with preserved ejection fraction.…”

Patient-Reported Barriers and Facilitators to Deprescribing Cardiovascular Medications

“…We conducted one-on-one, semi-structured interviews of consecutive patients (age ≥55 years) hospitalized for HF who were taking beta-blockers for HFpEF. Examining patients with HFpEF is well-suited for a study about deprescribing because multimorbidity (the condition of having multiple chronic conditions) [47] and polypharmacy are essentially universal in this condition [44,48]. Examining beta-blockers is well-suited because, despite their frequent use (up to 80% of patients with HFpEF take beta-blockers [37]) and inclusion in the clinical practice guidelines for HFpEF [38], there is substantial uncertainty regarding their potential benefits in HFpEF.…”

“…We excluded individuals who had other indications for beta-blockers such as arrhythmias and/or a history of myocardial infarction based on chart review. [44] We also excluded individuals with conditions that would preclude their participation in a qualitative interview, such as severe cognitive impairment, severe psychiatric disorder, and delirium. Among the 16 patients who were eligible to participate, 6 declined to participate and 10 provided in-person written consent and participated in the study.…”

“…To conduct this study, we opted to specifically focus on beta-blockers in heart failure with preserved ejection fraction (HFpEF) due to the frequent use of betablockers in this condition [37] and their inclusion on the clinical practice guidelines [38] despite substantial uncertainty regarding their benefits [39][40][41] and their potential to cause harm. [42][43][44][45][46]13].…”