Physician Perspectives on the Use of Beta Blockers in Heart Failure With Preserved Ejection Fraction

Musse, Mahad; Lau, Jennifer; Yum, Brian; Pinheiro, Laura C.; Curtis, Hannah; Anderson, Timothy S.; Steinman, Michael A.; Meyer, Markus; Dorsch, Michael P.; Hummel, Scott L.; Goyal, Parag

doi:10.1016/j.amjcard.2023.01.050

Cited by 8 publications

(3 citation statements)

References 24 publications

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“…MRA (eplerenone, potassium canrelate, and spironolactone) is an aldosterone antagonist and is also considered to have cardiovascular benefits when used in combination with ACE inhibitors (beta blockers) [10][11]. Arbs (such as Valsartan, Irbesartan, and kandisartan) not only block the binding of ATII to ATI receptors produced by ACE and non-ACE pathways, it also attenuated the myocardial damage and HF progression induced by overactivation of Raas by AT1R [12][13]. In clinical practice, the objective of dose increase should be the maximum tolerated dose [14~15].4.…”

Section: Treatment Of Chfmentioning

confidence: 99%

Exploring the therapeutic effect of Qijia Wuling soupon cardiomyocyte mast cells

2024

medcm

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The formation of cardiac hypertrophy is an important pathological change leading to chronic heart failure, which determines the development and prognosis of CHF. When the heart is damaged and stressed, the cardiomyocytes become hypertrophic and lead to changes in cellular metabolic patterns, which ultimately affect the structure and function of the heart. Qijia Wuling soup is the experience prescription of treating heart failure by the chief physician of Staff Liqin. In this study, we found that it could improve the echocardiographic parameters and relieve the symptoms of CHF in rats. In this study, the effect and mechanism of Qijia Wuling soup on myocardial hypertrophy in rats with CHF were investigated on the basis of the previous studies which proved that Qijia Wuling soup was effective in the treatment of CHF, to provide evidence for improving cardiac hypertrophy. H9C2 cells were inoculated into 6-well plate and randomly divided into control group and model group. Study it. This study demonstrated that qjwlt-containing serum had a significant protective effect on H9C2 cardiomyocytes injury induced by (-)-noradrenaline. This provides an important experimental and theoretical basis for the clinical application of qjwlt in the treatment of heart failure and improvement of cardiac hypertrophy. With the in-depth study of its mechanism of action, Qijia Wuling soupis expected to become one of the effective drugs in the treatment of CHF, bringing better therapeutic effect and quality of life for patients.

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Section: Treatment Of Chfmentioning

confidence: 99%

Exploring the therapeutic effect of Qijia Wuling soupon cardiomyocyte mast cells

2024

medcm

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“…Among patients with HFpEF, the prevalence of AF is between 40% and 60%, 64 which partially explains why over two-thirds of patients with HFpEF are treated with beta-blockers in contemporary studies. 41 , 42 , 65 In addition, just as HFpEF and AF increase sharply with age, the incidence of cardiac conduction disease requiring permanent pacing is projected to increase as the global population ages. 66 , 67 The prevalence of bradyarrhythmias requiring pacemaker implantation occurred in 1 in 5 HFpEF patients in a recent registry study.…”

Section: Moderately Accelerated Pacing Implementation: As Physiologic...mentioning

confidence: 99%

Accelerated physiologic pacing in patients with heart failure with preserved ejection fraction: An argument in support of therapeutic heart rate modulation

Infeld

2024

Heart Rhythm O2

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“…По данным B. Yum и соавт., 68% гериатрическим пациентам, госпитализированным в стационар по поводу ХСН с сохранной ФВ ЛЖ, при выписке были назначены β-АБ, при этом только 60% из них они были показаны в связи с другими причинами, такими как нарушения ритма сердца или перенесенный инфаркт миокарда [14]. Согласно опросу, почти четверть врачей назначают β-АБ больным ХСН с сохранной ФВ ЛЖ без четких показаний к ним, в то же время 40% врачей не отменяют назначенные ранее β-АБ или делают это редко [15].…”

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Beta-blockers in chronic heart failure with preserved left ventricular ejection fraction: is deprescribing possible?

Zakiev,

Vorobyeva,

Malaya

et al. 2023

Racionalʹnaâ farmakoterapiâ v kardiologii

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Chronic heart failure (CHF) is a complex clinical syndrome characterized by poor prognosis. According to the Russian epidemiological study EPOHA-CHF, more than half of patients with CHF have preserved left ventricular ejection fraction (LV EF). However, no class of drugs has proven effectiveness in improving the prognosis of this disease. Although current clinical guidelines do not recommend the routine use of beta-blockers in CHF patients with preserved LV EF in the absence of other indications for them, many patients with CHF with preserved LV EF take these drugs unreasonably. The review presents the data from studies on the efficacy and safety of betablockers in CHF with preserved LV EF and it withdrawal. Most studies included patient with LV EF >40%, a few of them analyzed only patients with LVEF ≥50%. Some studies of real clinical practice and meta-analysis of such studies demonstrated a positive effect of beta blockers in patients with LV EF > 40%, however randomized clinical trials and their meta-analyses revealed either a slight beneficial effect of beta-blockers. Studies involving only patients with LV EF ≥50% didn’t show the beneficial effects of beta blockers. There is only one trial accessing the withdrawal of beta blockers in patients with CHF with preserved LV EF and chronotropic insufficiency. The study showed a positive effect of deprescribing on exercise tolerance and quality of life. Due to controversial data, well-designed trials to examine the effect of beta-blockers on symptoms and prognosis in patients with CHF with LVEF ≥50% are required. Deprescribing of beta-blockers also require further assessment.

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Physician Perspectives on the Use of Beta Blockers in Heart Failure With Preserved Ejection Fraction

Cited by 8 publications

References 24 publications

Exploring the therapeutic effect of Qijia Wuling soupon cardiomyocyte mast cells

Exploring the therapeutic effect of Qijia Wuling soupon cardiomyocyte mast cells

Accelerated physiologic pacing in patients with heart failure with preserved ejection fraction: An argument in support of therapeutic heart rate modulation

Beta-blockers in chronic heart failure with preserved left ventricular ejection fraction: is deprescribing possible?

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