β-Blocker Doses and Heart Rate in Patients with Heart Failure: Results from the National Norwegian Heart Failure Registry

Eriksen-Volnes, Torfinn; Westheim, Arne; Gullestad, Lars; Slind, Eva Kjøl; Grundtvig, Morten

doi:10.1159/000505474

Cited by 4 publications

(3 citation statements)

References 37 publications

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“…Similarly, the Norwegian Heart Failure Registry reported that a high proportion of patients who had an HR ≥70 bpm were not treated with or/did not tolerate the target dose of β-blockers. The study additionally suggested that increased efforts should be made to further increase the β-blocker dose and treatment with Ivabradine could be considered among patients with an HR ≥70 bpm [ 41 ]. It is also important to understand the relationship between achieving β-blocker dose vs .…”

Section: Achieving Target Hr: Unmet Need In Ccs and Hfrefmentioning

confidence: 99%

Expert Consensus on Ivabradine-based Therapy for Heart Rate Management in Chronic Coronary Syndrome and Heart Failure with Reduced Ejection Fraction in India

Mohan

Sathyamurthy

Panja

et al. 2023

CCR

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Heart rate is an important indicator of health and disease and the modulation of heart rate can help to improve cardiovascular outcomes. Besides β-blockers, Ivabradine is a well-established modulating drug that reduces heart rate without any hemodynamic effects. This consensus document was developed with the help of expert opinions from cardiologists across India on effective heart rate management in routine clinical practice and choosing an appropriate Ivabradine-based therapy considering the available scientific data and guideline recommendations. Based on the discussion during the meetings, increased heart rate was recognized as a significant predictor of adverse cardiovascular outcomes among patients with chronic coronary syndromes and heart failure with reduced ejection fraction making heart rate modulation important in these subsets. Ivabradine is indicated in the management of chronic coronary syndromes and heart failure with reduced ejection fraction for patients in whom heart rate targets cannot be achieved despite guideline-directed β-blocker dosing or having contraindication/intolerance to β-blockers. A prolonged release once-daily dosage of Ivabradine can be considered in patients already stabilized on Ivabradine twice-daily. Ivabradine/β-blocker fixed-dose combination can also be considered to reduce pill burden. Two consensus algorithms have been developed to further guidance on the appropriate usage of Ivabradine-based therapies. Ivabradine and β-blockers can provide more pronounced clinical improvement in most chronic coronary syndromes and heart failure with reduced ejection fraction patients with a fixed-dose combination providing an opportunity to improve adherence.

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Section: Achieving Target Hr: Unmet Need In Ccs and Hfrefmentioning

confidence: 99%

Expert Consensus on Ivabradine-based Therapy for Heart Rate Management in Chronic Coronary Syndrome and Heart Failure with Reduced Ejection Fraction in India

Mohan

Sathyamurthy

Panja

et al. 2023

CCR

View full text Add to dashboard Cite

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“…As of 2012, 7.4 million individuals died from ischemic heart disease (IHD), which accounted for 15% of all deaths, according to the World Health Organization (WHO) [ 2 - 4 ]. Numerous cardiovascular disorders can be effectively treated with β-blockers [ 5 , 6 ]. Adrenergic β-receptor blockers have been used to treat CVD for many years.…”

Section: Introductionmentioning

confidence: 99%

Role of β-blockers in Preventing Heart Failure and Major Adverse Cardiac Events Post Myocardial Infarction

Johri

Matreja

Maurya

et al. 2023

CCR

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β-blockers have been widely utilized as a part of acute myocardial infarction (AMI) treatment for the past 40 years. Patients receiving β-adrenergic blockers for an extended period following myocardial infarction have a higher chance of surviving. Although many patients benefited from β-blockers, many do not, including those with myocardial infarction, left ventricle dysfunction, chronic pulmonary disease, and elderly people. In individuals with post-acute coronary syndrome and normal left ventricular ejection fraction (LVEF), the appropriate duration of beta-blocker therapy is still unknown. There is also no time limit for those without cardiac angina and who do not need β-blockers for dysrhythmia or hypertension. Interestingly, β-blockers have been prescribed for more than four decades. The novel mechanism of action on cellular compartments has been found continually, which opens a new way for their potential application in cardiac failure and other cardiac events like post-myocardial infarction. Here, in this review, we studied β-blocker usage in these circumstances and the current recommendations for β-blocker use from clinical practice guidelines.

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“…[18] In another study, it was discovered that of the patients whose targeted heart rate was not achieved in relation to the use of BARBs, 72.3% received less than the target dose of beta-blocker. [19] Even with high rates of EBBBs target doses being achieved in clinical trials, target dose attainment in clinical practice remains low, resulting in poor desired patient outcomes. [20,21] At the time our research was conducted, utilisation and optimisation of EBBBs among HF patients at the University Teaching Hospital in Lusaka, Zambia, had not yet been established and published.…”

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confidence: 99%

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Kampamba,

Mweetwa,

Mufwambi

et al. 2023

S Afr Med J

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Background. Beta-adrenergic receptor blocker (BARB) drugs are a wide range of medicines that are used in various conditions, including chronic heart failure (HF). Several studies have reported a wide-ranging inappropriate use of evidence-based beta-blockers (EBBBs) in chronic HF in both inpatients and outpatients. Objectives. To assess the utilisation and optimisation of EBBBs among patients with HF who presented with a reduced ejection fraction (HFrEF). Methods. A hospital-based retrospective cross-sectional study was carried out at the Adult University Teaching Hospital (AUTH), in Lusaka, Zambia, where patient medical files for the period of 1 July 2018 to 31 July 2021 were reviewed. Patient information, including file number, age, sex, type of BARB and the dose used, was recorded on the developed and validated checklist. Multivariable regression analysis was performed to identify factors associated with utilisation of BARBs. Results. Of the 173 medical records reviewed, BARBs were utilised in 101 (58.4%) patients. Among the patients who utilised BARBs, 96 (95.0%) were taking EBBBs, while the rest (n=5, 5.0 %) were taking atenolol, which is a non-EBBB. Among the patients who were on EBBBs, none of them received the optimal dose. Age ≥65 years (adjusted odds ratio (aOR) 0.3, 95% confidence interval (CI) 0.17 - 0.64), previous hospitalisation (aOR 0.3, 95% CI 0.13 - 0.51) and furosemide dose ≥40 mg (aOR 0.4, 95% CI 0.21 - 0.64) were significantly associated with lower likelihood of BARB utilisation. New York Heart Association (NYHA) class II (aOR 3.4, 95% CI 1.08 - 10.7), NYHA class III (aOR 4.8, 95% CI 1.65 - 13.7) and patients using at least 5 medications (aOR 5.0, 95% CI 2.91 - 8.77) were independent predictors of BARB utilisation. Conclusion. This study showed that 95.0% of chronic HF patients were utilising EBBBs, and none received the optimal dose as recommended in the guidelines. Pharmacotherapy with EBBBs should be optimised among patients with chronic HfrEF, as these drugs reduce both morbidity and mortality.

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β-Blocker Doses and Heart Rate in Patients with Heart Failure: Results from the National Norwegian Heart Failure Registry

Cited by 4 publications

References 37 publications

Expert Consensus on Ivabradine-based Therapy for Heart Rate Management in Chronic Coronary Syndrome and Heart Failure with Reduced Ejection Fraction in India

Expert Consensus on Ivabradine-based Therapy for Heart Rate Management in Chronic Coronary Syndrome and Heart Failure with Reduced Ejection Fraction in India

Role of β-blockers in Preventing Heart Failure and Major Adverse Cardiac Events Post Myocardial Infarction

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