Beta-blockers in chronic heart failure as recorded in the FAR NHL registr

Czech version

Authors: K. Lábr ¹; J. Špinar ²; J. Pařenica ²; L. Špinarová ¹; F. Málek ³; M. Špinarová ¹; O. Ludka ²; J. Jarkovský ⁴; K. Benešová ⁴; R. Lábrová ²
Authors‘ workplace: I. interní kardioangiologická klinika LF MU a FN u sv. Anny v Brně ¹; Interní kardiologická klinika LF MU a FN Brno ²; Kardiocentrum, Nemocnice Na Homolce, Praha ³; Institut biostatistiky a analýz, LF a PřF MU, Brno ⁴
Published in: Kardiol Rev Int Med 2017, 19(1): 68-72

Overview

Background:
Beta-blockers (BB) and angiotensin-converting-enzyme inhibitors (ACE-I) or angiotensin receptor blockers (ARB) are part of the first-line treatment of heart failure with reduced ejection fraction (HFrEF), leading to decreased morbidity and mortality. Methods: The data were collected from the Pharmacology and l Neurohumoral Activation Registry (FAR NHL). Patients with left ventricle ejection fraction (LV EF) under 50% who were stable for at least one month were included.

Results:
A total of 1,100 patients were included, median age was 65 years, 80.8% were male. Of all patients, 20% received low dose (LD), 57% medium dose (MD) and 17% high dose (HD). Of these, 6.2% of patients were not treated with BBs at all. The higher the blood pressure (BP; LD 124/77; MD 129/80; HD 132/82 mm Hg, p < 0.001), LV EF (LD 29.5; MD 30.5; HD 32.0%; p = 0.003), creatinine clearance rate (CrCl; LD 78.7; MD 87.8; HD 91.1 ml/min; p = 0.001) or body weight (LD 83.2; MD 88.7; HD 93.5 kg; p < 0.001) was, the higher the dose of BB they received. The lower the NT-proBNP level was, the higher the dose of BB they received (LD 767; MD 456; HD 314 pg/ml; p < 0.001). There was no difference in prescription of BB depending on the presence of atrial fibrillation (AF). Patients with AF were more often treated with digoxin or a combination of digoxin and BB than patients without AF (p < 0.001).

Summary:
Nearly 94% of HFrEF patients received BB, but only 17% received the target dose of BB. Ninety-nine % of patients treated with BB received one of the drugs recommended by the ESC Guidelines. The more severe the illness was, as expressed by lower BP, CrCl, LV EF, body weight and higher NT-proBNP, the lower the dose of BB the patients received and tolerated.

Keywords:
adrenergic beta-antagonists – heart failure – pro-brain natriuretic peptide – blood pressure – drug therapy – left ventricle ejection fraction – creatinine clearance

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