Dose-dependent efficacy of β-blocker in patients with chronic heart failure and atrial fibrillation

Campodonico, Jeness; Piepoli, Massimo F; Clemenza, Francesco; Bonomi, Alice; Paolillo, Stefania; Salvioni, Elisabetta; Corrà, Ugo; Binno, Simone; Veglia, Fabrizio; Lagioia, Rocco; Sinagra, Gianfranco; Cattadori, Gaia; Scardovi, Angela Beatrice; Metra, Marco; Senni, Michele; Scrutinio, Domenico; Raimondo, Rosa; Emdin, Michele; Magrì, Damiano; Parati, Gianfranco; Re, Federica; Cicoira, Mariantonietta; Minà, Chiara; Limongelli, Giuseppe; Correale, Michele; Frigerio, Maria; Bussotti, Maurizio; Perna, Enrico; Battaia, Elisa; Guazzi, Marco; Badagliacca, Roberto; Lenarda, Andrea Di; Maggioni, Aldo P.; Passino, Claudio; Sciomer, Susanna; Pacileo, Giuseppe; Mapelli, Massimo; Vignati, Carlo; Lombardi, Carlo; Filardi, Pasquale Perrone; Agostoni, Piergiuseppe

doi:10.1016/j.ijcard.2018.08.012

Cited by 13 publications

(11 citation statements)

References 31 publications

(53 reference statements)

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“…In particular, a sub-study of the AF-CHF trial [39], including 1,376 HF patients, performed a propensity-matched analysis considering treatment or not with β-blockers and reported that during a median follow-up of 37 months there was an association between treatment with β-blockers and lower rates of all-cause mortality (HR 0.72, 95% CI 0.54-0.94; p = 0.018), but not hospitalizations (HR 0.88; 95% CI 0.71-1.10; p = 0.223), irrespective of the pattern or burden of AF. More recently, a sub-analysis of the MECKI score registry [40] on 958 HFrEF patients with AF described that, at 10-year follow-up, patients treated with β-blockers had better outcomes with no differences between β1-selective drugs (53%) and β1-β2-blockers (47%), and that survival improved in parallel with β-blocker dose increase.…”

Section: β-Blockers and Atrial Fibrillationmentioning

confidence: 99%

The use of β-blockers in patients with heart failure and comorbidities: Doubts, certainties and unsolved issues

Paolillo

Dell’Aversana²,

Esposito³

et al. 2021

European Journal of Internal Medicine

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β-blockers represent a mainstay in the pharmacological approach to patients affected by heart failure with reduced ejection fraction (HFrEF). However, underuse of this class of drugs is still reported, especially in the presence of cardiovascular and non-cardiovascular comorbidities, even if they are not contraindications for prescription of a β-blocker. The prognostic benefit of β-blockers is relevant in the presence of comorbidities, and achievement of the maximum tolerated dose is an important goal to increase their favorable prognostic role. The aim of the present review is to analyze the available evidence on the use of β-blockers in HFrEF patients with the most common comorbidities. In particular, we will discuss the role and most appropriate beta-blocker in patients with pulmonary disease (bisoprolol, metoprolol, nebivolol), diabetes (carvedilol and nebivolol), atrial fibrillation (all indicated for rate control, with metoprolol as the first choice followed by bisoprolol, nebivolol, and carvedilol), erectile dysfunction (bisoprolol and nebivolol), peripheral arterial disease (nebivolol), and other conditions, in order to clarify the correct use of this class of drugs in the clinical practice.

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Section: β-Blockers and Atrial Fibrillationmentioning

confidence: 99%

The use of β-blockers in patients with heart failure and comorbidities: Doubts, certainties and unsolved issues

Paolillo

Dell’Aversana²,

Esposito³

et al. 2021

European Journal of Internal Medicine

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“…Modified from Campodonico et al 42 that, at 10-year follow-up, patients treated with b-blockers had a better outcome with no effects as regards b1-selective drugs (53%) versus b1-b2 blockers (47%) and that survival improved in parallel with b-blocker dose increase (Figure 3). 43 New studies are still needed regarding the dangerous liaison between atrial fibrillation and heart failure: first, on the effects of sinus rhythm restoration on exercise performance, drugs, treatment and prognosis; similarly, different rate control strategies in atrial fibrillation heart failure patients.…”

Section: Atrial Fibrillationmentioning

confidence: 99%

“…The analysis of data derived from 958 heart failure patients with atrial fibrillation as part of the MECKI score database allowed to define that, at 10-year follow-up, patients treated with β-blockers had a better outcome with no effects as regards β1-selective drugs (53%) versus β1-β2 blockers (47%) and that survival improved in parallel with β-blocker dose increase (Figure 3). 43…”

Section: Atrial Fibrillationmentioning

confidence: 99%

Role of comorbidities in heart failure prognosis Part I: Anaemia, iron deficiency, diabetes, atrial fibrillation

Paolillo¹,

Scardovi

Campodonico

2020

European Journal of Preventive Cardiology

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Cardiovascular and non-cardiovascular comorbidities are frequently observed in heart failure patients, complicating the therapeutic management and leading to poor prognosis. The prompt recognition of associated comorbid conditions is of great importance to optimize the clinical management, the follow-up, and the treatment of patients affected by chronic heart failure. Anaemia and iron deficiency are commonly reported in all heart failure forms, have a multifactorial aetiology and are responsible for reduced exercise tolerance, impaired quality of life, and poor long-term prognosis. Diabetes mellitus is highly prevalent in heart failure and a poor glycaemic control is associated with worst outcome. Two specific heart failure forms are usually observed in diabetic patients: an ischaemic cardiomyopathy or a typical diabetic cardiomyopathy. The implementation of use of sodium-glucose cotransporter-2 inhibitors will much improve in the near future the long-term prognosis of patients affected by heart failure and diabetes. Among cardiovascular comorbidities, atrial fibrillation is the most common arrhythmic disease of heart failure patients and it is still not clear whether its presence should be considered as a prognostic indicator or as a marker of advanced disease. The aim of the present review was to explore the clinical and prognostic impact of anaemia and iron deficiency, diabetes mellitus, and atrial fibrillation in patients affected by chronic heart failure.

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“…2 However, most heart failure patients included in clinical trials with β-blockers were in sinus rhythm, with only 11% to 35% of patients with atrial fibrillation, data on survival often being inconclusive. 30 A paper from the MECKI score database 31 pointed out that heart failure patients with permanent atrial fibrillation have a better outcome if treated with β-blockers. Moreover, the association between β-blockers and survival improvement was in parallel with daily β-blocker dose increase.…”

Section: β-Blockers and Heart Failure Prognosis In Special Settingmentioning

confidence: 99%

Beta-blockers in heart failure prognosis: Lessons learned by MECKI Score Group papers

Cattadori

Marco

Farina

et al. 2020

European Journal of Preventive Cardiology

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Heart failure is a complex syndrome affecting several organs including kidney, lungs, liver, brain muscles and sympathetic system. Each of these organs might contribute to its severity and prognosis. The prognosis assessment is critical for a correct heart failure management. It has already been demonstrated that a single parameter is weaker for prognosis than different parameters combined. The Metabolic Exercise test data combined with Cardiac and Kidney Indexes (MECKI) score has been built and validated for heart failure with reduced ejection fraction (HFrEF) patients by considering cardiopulmonary exercise test data combined with clinical, laboratory and echocardiographic measurements. The betablockers treatment is a milestone in the HFrEF management. In the MECKI score database, the association of betablockers treatment with outcome has been investigated in different settings.

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Dose-dependent efficacy of β-blocker in patients with chronic heart failure and atrial fibrillation

Cited by 13 publications

References 31 publications

The use of β-blockers in patients with heart failure and comorbidities: Doubts, certainties and unsolved issues

The use of β-blockers in patients with heart failure and comorbidities: Doubts, certainties and unsolved issues

Role of comorbidities in heart failure prognosis Part I: Anaemia, iron deficiency, diabetes, atrial fibrillation

Beta-blockers in heart failure prognosis: Lessons learned by MECKI Score Group papers

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