Optimized Treatment and Heart Rate Reduction in Chronic Heart Failure

Abstract

BackgroundHeart failure (HF) is a syndrome that leads to poor outcome in advanced forms. The neurohormonal blockade modifies this natural history; however, it is often suboptimal. ObjectiveThe aim of this study is to assess at what percentage cardiologists used to treating HF can prescribe target doses of drugs of proven efficacy. MethodsA total of 104 outpatients with systolic dysfunction were consecutively enrolled, all under stabilized treatment. Demographic and treatment data were evaluated and the doses achieved were verified. The findings are shown as percentages and correlations are made between different variables. ResultsThe mean age of patients was 64.1 ± 14.2 years, with SBP =115.4 ± 15.3, HR = 67.8 ± 9.4 bpm, weight = 76.0 ± 17.0 kg and sinus rhythm (90.4%). As for treatment, 93.3% received a RAS blocker (ACEI 52.9%), all received beta-blockers (BB), the most often prescribed being carvedilol (92.3%). As for the doses: 97.1% of those receiving an ARB were below the optimal dose and of those who received ACEI, 52.7% received an optimized dose. As for the BB, target doses were prescribed to 76.0% of them. In this group of patients, most with BB target dose, it can be seen that 36.5% had HR ≥ 70 bpm in sinus rhythm. ConclusionCardiologists used to treating HF can prescribe target doses of ACEI and BB to most patients. Even though they receive the recommended doses, about one third of patients persists with HR > 70 bpm and should have their treatment optimized.

O Tratamento Medicamentoso Habitual é Suficiente para Manter o Controle da Frequência Cardíaca nos Pacientes com Insuficiência Cardíaca?

“…No estudo MERIT-HF, identificaram-se dois grupos: um que teve redução da FC com doses baixas de metoprolol (dose média 76 mg/dia) e outro que necessitou da dose-alvo para reduzir a FC (dose média 195 mg/dia). 16 Essa possível diferença pode ser geneticamente determinada, 16 sendo alguns pacientes muito responsivos às doses dos medicamentos. 16 Quanto aos resultados do estudo, os autores sinalizaram que a redução de eventos não foi estatisticamente diferente nos dois grupos, indicando que a redução de FC foi mais importante que a dose do betabloqueador na redução de eventos cardiovasculares.…”

“… 16 Essa possível diferença pode ser geneticamente determinada, 16 sendo alguns pacientes muito responsivos às doses dos medicamentos. 16 Quanto aos resultados do estudo, os autores sinalizaram que a redução de eventos não foi estatisticamente diferente nos dois grupos, indicando que a redução de FC foi mais importante que a dose do betabloqueador na redução de eventos cardiovasculares. 16 …”

“… 16 Quanto aos resultados do estudo, os autores sinalizaram que a redução de eventos não foi estatisticamente diferente nos dois grupos, indicando que a redução de FC foi mais importante que a dose do betabloqueador na redução de eventos cardiovasculares. 16 …”

“…In the MERIT-HF study, two groups of patients were identified – one group that showed a HR reduction in response to low doses of metoprolol (mean 76 mg/day) and another group that achieve HR reduction in response to high doses of metoprolol (mean 195 mg/day). 16 Such difference may be genetically determined, with some of the patients highly responsive to relatively low doses of medications. 16 The authors pointed out that the reduction in events was not different between the two groups, indicating that HR reduction was a more important determinant to reduction of cardiovascular events compared with the beta blocker dose.…”

β-Blockade in Heart Failure With Reduced Ejection Fraction: Does Heart Rate Control Influence Readmissions?

“…13 Subsequent studies have also indicated that achievement of target β-blocker dose is unrelated to achievement of target HR. 14,15 Given this lack of correlation, the question may be raised whether it would be more prudent to titrate to a recommended HR rather than a maximum tolerated β-blocker dose, as is currently the standard of practice.…”