AimsThe use of -blockers represents a milestone in the treatment of heart failure with reduced ejection fraction (HFrEF). Few studies have compared -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 -blocker treatment with a composite outcome of cardiovascular death, urgent heart transplantation or left ventricular assist device implantation, addressing the role of -selectivity and dosage regimens.Methods and resultsIn 5242 HFrEF patients, we investigated the role of: (i) -blocker treatment vs. non--blocker treatment, (ii) 1-/2-receptor-blockers vs. 1-selective blockers, and (iii) daily -blocker dose. Patients were followed for 3.58years, and 1101 events (18.3%) were observed; 4435 patients (86.8%) were on -blockers, while 807 (13.2%) were not. At 5years, -blocker-patients showed a better outcome than non--blocker-subjects [hazard ratio (HR) 0.48, P<0.0001], while also considering potential confounders. A comparable prognosis was observed at 5years in the 1-/2-receptor-blocker (n=2219) vs. 1-selective group (n=2216) (HR 0.95, P=ns). A better prognosis was observed in high-dose (>25mg carvedilol equivalent daily dose, n=1005) patients than in both medium dose (12.5-25mg, n=1431) and low dose (<12.5mg, 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).ConclusionIn a large population of chronic HFrEF patients, -blockers were associated with a more favourable prognosis without any difference between 1- and 2-receptor-blockers vs. 1-selective blockers. A better outcome was observed in subjects receiving a high daily dose.
Prognostic role of beta-blocker selectivity and dosage regimens in heart failure patients. Insights from the MECKI score database
Limongelli, Giuseppe;
2017
Abstract
AimsThe use of -blockers represents a milestone in the treatment of heart failure with reduced ejection fraction (HFrEF). Few studies have compared -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 -blocker treatment with a composite outcome of cardiovascular death, urgent heart transplantation or left ventricular assist device implantation, addressing the role of -selectivity and dosage regimens.Methods and resultsIn 5242 HFrEF patients, we investigated the role of: (i) -blocker treatment vs. non--blocker treatment, (ii) 1-/2-receptor-blockers vs. 1-selective blockers, and (iii) daily -blocker dose. Patients were followed for 3.58years, and 1101 events (18.3%) were observed; 4435 patients (86.8%) were on -blockers, while 807 (13.2%) were not. At 5years, -blocker-patients showed a better outcome than non--blocker-subjects [hazard ratio (HR) 0.48, P<0.0001], while also considering potential confounders. A comparable prognosis was observed at 5years in the 1-/2-receptor-blocker (n=2219) vs. 1-selective group (n=2216) (HR 0.95, P=ns). A better prognosis was observed in high-dose (>25mg carvedilol equivalent daily dose, n=1005) patients than in both medium dose (12.5-25mg, n=1431) and low dose (<12.5mg, 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).ConclusionIn a large population of chronic HFrEF patients, -blockers were associated with a more favourable prognosis without any difference between 1- and 2-receptor-blockers vs. 1-selective blockers. A better outcome was observed in subjects receiving a high daily dose.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
