Optimised Beta Blocker Therapy in Heart Failure
HR control remains suboptimal (HR ≥70 bpm) in 41.9% of patients after optimisation of conventional medical therapy despite 84.3% of patients receiving beta blockers and half of this cohort taking at least 50% of the maximum recommended dose. The side effect profile and hypotensive effects of beta blockers limit their up-titration and scope to effectively control HR. However, we were able to establish 27/47 (57.4%) of patients on beta blockers who had previously discontinued this therapy.
The primary site of inhibition of the If ionic current is the sinus node. Therefore, the 18 subjects in atrial fibrillation with ejection fraction ≤35% and HR ≥70 bpm would not benefit from an If inhibitor despite suboptimal HR control. This reflects the high burden of atrial fibrillation (41.3%) in our HF population.
The subgroup of patients most likely to benefit from additional HR control are the subjects who are either intolerant or who take ≤50% of maximum dose of beta blocker. In our study there were 11/31 (35.5%) subjects in sinus rhythm, ejection fraction ≤35% and HR ≥70 bpm taking either ≤50% maximum dose of beta blocker or no beta blocker.
This study highlights the prescribing habits and haemodynamic profiles of patients attending an established HF clinic. The limitations of this study include the retrospective data acquisition and the sample size. However, the data do reflect 'real life' practice as compared with data from randomised-controlled trials.
Discussion
HR control remains suboptimal (HR ≥70 bpm) in 41.9% of patients after optimisation of conventional medical therapy despite 84.3% of patients receiving beta blockers and half of this cohort taking at least 50% of the maximum recommended dose. The side effect profile and hypotensive effects of beta blockers limit their up-titration and scope to effectively control HR. However, we were able to establish 27/47 (57.4%) of patients on beta blockers who had previously discontinued this therapy.
The primary site of inhibition of the If ionic current is the sinus node. Therefore, the 18 subjects in atrial fibrillation with ejection fraction ≤35% and HR ≥70 bpm would not benefit from an If inhibitor despite suboptimal HR control. This reflects the high burden of atrial fibrillation (41.3%) in our HF population.
The subgroup of patients most likely to benefit from additional HR control are the subjects who are either intolerant or who take ≤50% of maximum dose of beta blocker. In our study there were 11/31 (35.5%) subjects in sinus rhythm, ejection fraction ≤35% and HR ≥70 bpm taking either ≤50% maximum dose of beta blocker or no beta blocker.
This study highlights the prescribing habits and haemodynamic profiles of patients attending an established HF clinic. The limitations of this study include the retrospective data acquisition and the sample size. However, the data do reflect 'real life' practice as compared with data from randomised-controlled trials.
Source...