Has Beta-blocker Use Increased in Patients With Heart Failure in Internal Medicine Settings? Prognostic Implications: RICA Registry

García, Andrés González; Pérez-Barquero, Manuel Montero; Formiga, Francesç; González-Juanàtey, José Ramón; Quesada, María Angustias; Epelde, Francisco; Oropesa, Roberto; Díez-Manglano, Jesús; Cerqueiro, J.M.; Manzano, Luís

doi:10.1016/j.rec.2013.07.012

Cited by 8 publications

(7 citation statements)

References 25 publications

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“…The same reasoning would be valid for global comorbidity [24]. Finally our results confirm the importance of starting treatment with beta-blockers in patients with HF, and even after the first decompensation [25]. In RICA patients with new onset HF there was no difference in mortality at 3 months of follow-up according to the EF values, a result similar to those recently …”

Section: Discussionsupporting

confidence: 88%

New onset heart failure — Clinical characteristics and short-term mortality. A RICA (Spanish registry of acute heart failure) study

Franco¹,

Formiga²,

Chivite³

et al. 2015

European Journal of Internal Medicine

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Section: Discussionsupporting

confidence: 88%

New onset heart failure — Clinical characteristics and short-term mortality. A RICA (Spanish registry of acute heart failure) study

Franco¹,

Formiga²,

Chivite³

et al. 2015

European Journal of Internal Medicine

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“…Despite these issues, the subscription of ACE‐Is and beta‐blockers in 100% and 98% of patients is a remarkable achievement. For example, in a Spanish prospective cohort of patients hospitalized for HF from 2008 to 2011, beta‐blockers were after 12 months only present in 68% of patients, and numbers also seen in other registries like the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure (OPTIMIZE‐HF) registry . In this latter trial, target doses of metoprolol and carvedilol were seen in only 8% and 18% of patients 3 months after discharge.…”

Section: Discussionmentioning

confidence: 76%

Evolution of mitral regurgitation in patients with heart failure referred to a tertiary heart failure clinic

et al. 2019

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Aims Significant mitral regurgitation (MR) is an important predictor for all-cause mortality and heart failure (HF) hospitalizations independent of left ventricular ejection fraction (LVEF). The aims of this study were to investigate (i) in how many patients referred to a tertiary outpatient HF clinic HF therapy could be optimized, (ii) the effect of optimized treatment on MR severity, and (iii) whether a reduction in MR resulted in improvement of symptoms. Methods and results Forty-seven referred patients with therapy-resistant symptomatic chronic HF with an LVEF <40% and at least moderate MR were analysed on admission and after optimization of HF treatment after 6-18 months. The patients were classified as a volume responder when LV end-systolic volume (LVESV) decreased ≥15%, as LVEF responder when LVEF increased by ≥5% points, as clinical responder when New York Heart Association (NYHA) class improved at least one category, and as MR responder when MR severity improved at least one category to maximally moderate. After 14 ± 4 months of treatment optimization, optimal doses of angiotensin-converting enzyme inhibitors/angiotensin receptor blocker were seen in 18 (38%) patients compared with three (6%) at baseline (P < 0.001), and optimal doses of beta-blockers were seen in 14 (30%) patients compared with four (9%) at baseline (P < 0.001). In total, 68% of the patients were clinical responders, 57% MR responders, 34% volumetric responders, and 49% LVEF responders. NYHA class improved from 2.9 ± 0.6 to 2.0 ± 0.9 (P < 0.001), MR class from 5.2 ± 0.8 to 3.6 ± 1.5 (P < 0.001), LVEF from 24% ± 9% to 31% ± 12% (P < 0.01), and LVESV non-significantly improved. The positive predictive value of MR response to NYHA response was 88%; the negative predictive value was 53%, agreement 69%, and kappa 0.39. The positive predictive value of LVEF response to NYHA response was 76%; the negative predictive value was 44%, agreement 60%, and kappa 0.21. The positive predictive value of LVESV volume response to NYHA response was 75%; the negative predictive value was 39%, agreement 51%, and kappa 0.12. Conclusions Although this study was limited by a small number of patients, initiation and up-titration of recommended HF therapy in patients referred to our tertiary HF outpatient clinic resulted in significant MR reduction in over half of the patients, emphasizing the importance of optimal medical treatment in these very sick cardiac patients with otherwise grave prognosis. MR reduction was best correlated to NYHA improvement.

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“…As with other authors, 3,10 we observed a tendency toward increased use of beta-blockers, as shown in a recent study performed with patients of the RICA registry. 31 Our study had a number of limitations. Patients who died during hospitalization were not included in the registry.…”

Section: Discussionmentioning

confidence: 94%

Gender-related differences in clinical profile and outcome of patients with heart failure. Results of the RICA Registry

Conde‐Martel

Arkuch

Formiga

et al. 2015

Revista Clínica Española (English Edition)

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Has Beta-blocker Use Increased in Patients With Heart Failure in Internal Medicine Settings? Prognostic Implications: RICA Registry

Cited by 8 publications

References 25 publications

New onset heart failure — Clinical characteristics and short-term mortality. A RICA (Spanish registry of acute heart failure) study

New onset heart failure — Clinical characteristics and short-term mortality. A RICA (Spanish registry of acute heart failure) study

Evolution of mitral regurgitation in patients with heart failure referred to a tertiary heart failure clinic

Gender-related differences in clinical profile and outcome of patients with heart failure. Results of the RICA Registry

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