Prognostic role of β‐blocker selectivity and dosage regimens in heart failure patients. Insights from the MECKI score database

Abstract

In a large population of chronic HFrEF patients, β-blockers were associated with a more favourable prognosis without any difference between β1- and β2-receptor-blockers vs. β1-selective blockers. A better outcome was observed in subjects receiving a high daily dose.

Dose-dependent efficacy of β-blocker in patients with chronic heart failure and atrial fibrillation

“…Finally, we also evaluated the role of daily β-blocker dose, grouping patients according to carvedilol-equivalent dose (group 1 ≤ 12.5 mg/day, group 2 >12.5-≤25 mg/day and group 3 > 25 mg/day). The carvedilol-equivalent dose was calculated for nebivolol and bisoprolol as dose x 5, and for metoprolol as dose/4 [17,22]. Again, Kaplan-Meyer survival curves were normalized for the same confounding factors.…”

“…Moreover, the effects of β-blockers on survival in HF patients is dose-dependent, so that the higher the dose, the better the survival rate [17][18][19][20]. Unfortunately, the β-blocker dose is unknown, at least in most of the studies on HF patients with atrial fibrillation, and this generates a further theme of uncertainty.…”

“…Moreover, it should be noted that clinical trials dedicated to understanding the efficacy of β-blockers in patients with HF and concomitant atrial fibrillation do not exist, and that the available information only derives from observational studies or sub-analyses of trials on HF. To contribute to the knowledge on this topic, we analyzed the MECKI (Metabolic Exercise Cardiac Kidney Index) score database, which is a multicenter, progressively enrolling, continuously updated research program on HF patients capable to perform a cardiopulmonary exercise test [17,21]. We identified HF patients with permanent atrial fibrillation, which are the source of the present analysis, and we compared the survival of those with and without β-blockers, and the outcome predictors, also in relation with β-blocker doses.…”

Comparison of cardiopulmonary‐based risk models with a clinical heart failure risk model

“…The risk associated with a 1 mL/kg/min decrease in pVO 2 is 50% lower with beta‐blockers . The MECKI investigators reported a 43% adjusted lower risk of cardiovascular death/urgent transplant with beta‐blocker use, although this important variable is not included in the MECKI model. Women have a lower risk of death for the same pVO 2 in many cohorts.…”

July 2017 at a glance: clinical assessment, biomarkers, cardiac imaging and treatment

“…It was confirmed the better survival of patients on β‐blockers without, however, differences depending on the type of β‐blocker administered. Patients receiving higher β‐blocker doses had better outcomes …”