The use of β-blockers in patients with heart failure and comorbidities: Doubts, certainties and unsolved issues

Paolillo, Stefania; Dell’Aversana, Simona; Esposito, Immacolata; Poccia, Alessandra; Filardi, Pasquale Perrone

doi:10.1016/j.ejim.2021.03.035

Cited by 25 publications

(17 citation statements)

References 47 publications

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“…In this study, an inversely proportional relationship was found between the rate of patients who have been using beta‐blockers and AHRE prevalence. This relationship might be explained by the direct negative inotropic effects of beta‐blockers on the atrial myocardium or to the fact that beta‐blockers reduced the undesirable effects of augmented sympathetic nervous system on the left atrium slowing down the atrial remodeling and atrial cardiomyopathy 28,29 …”

Section: Discussionmentioning

confidence: 99%

Value of ATRIA stroke risk score in predicting atrial high‐rate episodes: A comparison of six different risk scores

Artaç

Karakayalı

Omar

et al. 2023

Pacing Clinical Electrophis

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ObjectivesAtrial high‐rate episodes (AHRE) are asymptomatic atrial tachy‐arrhythmias detected through continuous monitoring with a cardiac implantable electronic device (CIED). AHRE's have been associated with increased risks of developing clinically manifested atrial fibrillation (AF), thromboembolism, cardiovascular events, and mortality. Several variables has been researched and identified to predict AHRE development. The aim of this study, which compared the six frequently‐used scoring systems for thromboembolic risk in AF (CHA2DS2‐VASc, mC2HEST, HAT2CH2, R2‐CHADS2, R2‐CHA2DS2‐VASc, and ATRIA) in terms of their prognostic power in predicting AHRE.Materials and methodsThis retrospective study included 174 patients with CIED's. The study population was divided into two groups according to presence of AHRE: patients with AHRE (+) and patients without AHRE (‐). Thereafter, patients baseline characteristics and scoring systems were analyzed for prediction of AHRE.ResultsThe distribution of patients’ baseline characteristics and scoring systems according to presence of AHRE was evaluated. Furthermore, ROC curve analyses of the stroke risk scoring systems have been investigated in terms of predicting the development of AHREs. ATRIA, which predicted AHRE with a specificity of 92% and sensitivity of 37.5% for ATRIA values of >6, performed better than other scoring systems in predicting AHRE (AUC: 0.700, 0.626‐0.767 95% confidence interval (CI), p = .004)ConclusionAHRE is common in patients with a CIED. In this context, several risk scoring systems have been used to predict the development of AHRE in patients with a CIED. This study's findings revealed that The ATRIA stroke risk scoring system performed better than other commonly used risk scoring systems in predicting AHRE.

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Section: Discussionmentioning

confidence: 99%

Value of ATRIA stroke risk score in predicting atrial high‐rate episodes: A comparison of six different risk scores

Artaç

Karakayalı

Omar

et al. 2023

Pacing Clinical Electrophis

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“…In fact, carvedilol may cause a greater impairment in lung diffusion capacity than cardio-selective BBs due to the alveolar β2 blockade ( 76 ). Moreover, the β1-selective bisoprolol showed higher forced expiratory volume in 1 s than carvedilol ( 77 ), while carvedilol led to a higher risk of HF hospitalization ( 78 ) and, consequently, to COPD exacerbation than cardio-selective BBs ( 79 ). Nonetheless, a similar trend in prescriptions of carvedilol was found in several studies that reported that about one-third of patients affected by HF and COPD were treated with carvedilol ( 80 , 81 ).…”

Section: Discussionmentioning

confidence: 99%

Beta-Blocker Use in Older Hospitalized Patients Affected by Heart Failure and Chronic Obstructive Pulmonary Disease: An Italian Survey From the REPOSI Register

Arcoraci

Squadrito

Rottura

et al. 2022

Front. Cardiovasc. Med.

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Beta (β)-blockers (BB) are useful in reducing morbidity and mortality in patients with heart failure (HF) and concomitant chronic obstructive pulmonary disease (COPD). Nevertheless, the use of BBs could induce bronchoconstriction due to β2-blockade. For this reason, both the ESC and GOLD guidelines strongly suggest the use of selective β1-BB in patients with HF and COPD. However, low adherence to guidelines was observed in multiple clinical settings. The aim of the study was to investigate the BBs use in older patients affected by HF and COPD, recorded in the REPOSI register. Of 942 patients affected by HF, 47.1% were treated with BBs. The use of BBs was significantly lower in patients with HF and COPD than in patients affected by HF alone, both at admission and at discharge (admission, 36.9% vs. 51.3%; discharge, 38.0% vs. 51.7%). In addition, no further BB users were found at discharge. The probability to being treated with a BB was significantly lower in patients with HF also affected by COPD (adj. OR, 95% CI: 0.50, 0.37–0.67), while the diagnosis of COPD was not associated with the choice of selective β1-BB (adj. OR, 95% CI: 1.33, 0.76–2.34). Despite clear recommendations by clinical guidelines, a significant underuse of BBs was also observed after hospital discharge. In COPD affected patients, physicians unreasonably reject BBs use, rather than choosing a β1-BB. The expected improvement of the BB prescriptions after hospitalization was not observed. A multidisciplinary approach among hospital physicians, general practitioners, and pharmacologists should be carried out for better drug management and adherence to guideline recommendations.

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“…Cardiac remodeling is a main step in the progression of HFrEF and is characterized by changes in LV geometry and in myocardial function; it is associated with an increased risk of adverse events and represents an important therapeutic target. In HFrEF, the beneficial effect of betablockers [35,36], ACEi, ARBs, and MRA on cardiac remodeling has been related to reduced levels of natriuretic peptides and to reduced mortality rates [3].…”

Section: Mechanisms Of Sacubitril/valsartan Benefit On Clinical Outcomesmentioning

confidence: 99%

Renin-angiotensin-aldosterone system inhibition in patients affected by heart failure: efficacy, mechanistic effects and practical use of sacubitril/valsartan. Position Paper of the Italian Society of Cardiology

Perrone‐Filardi

Paolillo

Agostoni

et al. 2022

European Journal of Internal Medicine

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The use of β-blockers in patients with heart failure and comorbidities: Doubts, certainties and unsolved issues

Cited by 25 publications

References 47 publications

Value of ATRIA stroke risk score in predicting atrial high‐rate episodes: A comparison of six different risk scores

Value of ATRIA stroke risk score in predicting atrial high‐rate episodes: A comparison of six different risk scores

Beta-Blocker Use in Older Hospitalized Patients Affected by Heart Failure and Chronic Obstructive Pulmonary Disease: An Italian Survey From the REPOSI Register

Renin-angiotensin-aldosterone system inhibition in patients affected by heart failure: efficacy, mechanistic effects and practical use of sacubitril/valsartan. Position Paper of the Italian Society of Cardiology

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