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Eur J Heart Fail. 2017 Jul;19(7):904-914. doi: 10.1002/ejhf.775. Epub 2017 Feb 24.

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

Author information

1
IRCCS SDN, Naples, Italy.
2
Centro Cardiologico Monzino, IRCCS, Milan, Italy.
3
Division of Cardiac Rehabilitation, Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Veruno, Veruno, Italy.
4
Cardiac Department, Guglielmo da Saliceto Hospital, Piacenza, Italy.
5
Cardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy.
6
Division of Cardiology, Salvatore Maugeri Foundation, IRCCS, Scientific Institute of Cassano Murge, Bari, Italy.
7
Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.
8
Cardiology SUN, Monaldi Hospital (Azienda dei Colli), Second University of Naples, Naples, Italy.
9
Cardiac Rehabilitation, San Giuseppe Hospital, Multimedica Spa, IRCCS, Milan, Italy.
10
Cardiology Division, Santo Spirito Hospital, Rome, Italy.
11
Department of Cardiovascular, Respiratory, Nephrology, Anesthesiology, and Geriatric Sciences, 'Sapienza' University of Rome, Rome, Italy.
12
Salvatore Maugeri, Foundation IRCCS, Scientific Institute of Tradate, Italy.
13
Life Science Institute, Scuola Superiore Sant'Anna, Pisa, Italy.
14
Gabriele Monasterio, Foundation CNR-Regione Toscana, Pisa, Italy.
15
Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, 'Sapienza' University of Rome, Rome, Italy.
16
Department of Cardiology, University of Foggia, Foggia, Italy.
17
Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano, Milan, Italy.
18
Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
19
Cardiology Division, Cardiac Arrhythmia Centre and Cardiomyopathies Unit, San Camillo-Forlanini Hospital, Rome, Italy.
20
Section of Cardiology, Department of Medicine, University of Verona, Verona, Italy.
21
'A. De Gasperis' Cardio Center, Niguarda Hospital, Milan, Italy.
22
Cardiac Rehabilitation Unit, Salvatore Maugeri, Foundation, IRCCS, Scientific Institute of Milan, Milan, Italy.
23
Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation IRCCS - ISMETT, Palermo, Italy.
24
Department of Cardiology, S. Chiara Hospital, Trento, Italy.
25
Cardiac Rehabilitation, Azienda Ospedali Riuniti, Ancona, Italy.
26
Cardiovascular Center, Health Authority n. 1 and University of Trieste, Trieste, Italy.
27
Papa Giovanni XXIII Hospital, Bergamo, Italy.
28
Cardiology University Department, Heart Failure Unit and Cardiopulmonary Laboratory, IRCCS Policlinico San Donato, San Donato, Milan, Italy.
29
Department of Advanced Biomedical Sciences, 'Federico II' University of Naples, Naples, Italy.
30
Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy.

Abstract

AIMS:

The use of β-blockers represents a milestone in the treatment of heart failure with reduced ejection fraction (HFrEF). Few studies have compared β-blockers in HFrEF, and there is little data on the effects of different doses. The present study aimed to investigate in a large database of HFrEF patients (MECKI score database) the association of β-blocker treatment with a composite outcome of cardiovascular death, urgent heart transplantation or left ventricular assist device implantation, addressing the role of β-selectivity and dosage regimens.

METHODS AND RESULTS:

In 5242 HFrEF patients, we investigated the role of: (i) β-blocker treatment vs. non-β-blocker treatment, (ii) β1-/β2-receptor-blockers vs. β1-selective blockers, and (iii) daily β-blocker dose. Patients were followed for 3.58 years, and 1101 events (18.3%) were observed; 4435 patients (86.8%) were on β-blockers, while 807 (13.2%) were not. At 5 years, β-blocker-patients showed a better outcome than non-β-blocker-subjects [hazard ratio (HR) 0.48, P < 0.0001], while also considering potential confounders. A comparable prognosis was observed at 5 years in the β1-/β2-receptor-blocker (n = 2219) vs. β1-selective group (n = 2216) (HR 0.95, P = ns). A better prognosis was observed in high-dose (>2 5 mg carvedilol equivalent daily dose, n = 1005) patients than in both medium dose (12.5-25 mg, n = 1431) and low dose (<12.5 mg, n = 1960) (HR 1.97, P < 0.001; HR 1.95, P = 0.001, respectively), with no differences between the last two groups (HR 0.84, P = ns).

CONCLUSION:

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.

KEYWORDS:

Equivalent dose; Heart failure; Prognosis; β-Blocker selectivity; β-Blockers

PMID:
28233458
DOI:
10.1002/ejhf.775
[Indexed for MEDLINE]
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