Programme to improve the use of beta‐blockers for heart failure in the elderly and in those with severe symptoms: Results of the BRING‐UP 2 Study

Abstract

Background: Beta-blockers are underused in HF patients, thus strategies to implement their use are needed. Objectives: To improve beta-blocker use in elderly and/or patients with severe heart failure (HF) and to evaluate safety and outcome. Methods: Patients with symptomatic HF and age ! 70 years or left ventricular EF < 25% and symptoms at rest were enrolled, including those already on beta-blocker treatment. Patients who were not receiving a beta-blocker were considered for carvedilol treatment. All patients were followed up for 1-year. Results: Of the 1518 elderly patients, 505 were already on beta-blockers, and carvedilol was newly prescribed in 419 patients. At 1-year, patients treated with carvedilol had a lower incidence of death [10.8% vs. 18.0% in already treated (adjusted RR 0.68; 95%CI 0.49 -0.96) and 11.2% in newly treated patients (adjusted RR 0.68; 95%CI 0.48 -0.97)].Of the 709 patients with severe HF, 38.4% were already on beta-blockers, and carvedilol was newly prescribed in 189 patients. Patients not treated with carvedilol showed the worst clinical outcome. Total rate of discontinuation (including adverse reaction and non-compliance) was 14% and 9%, respectively, in elderly and severe patients. Conclusions: In a real world setting, beta-blocker treatment was not associated with an increased risk of adverse events in elderly and severe HF patients.

Treatment of chronic heart failure with carvedilol in daily practice: The SATELLITE survey experience

“…In most instances dose adjustment was sufficient or no action was deemed necessary. These findings are in line with available data from daily practice [15,[19][20][21][22]25] and support the introduction of β-blockers, in particular carvedilol, in patients with CHF seen in daily practice.…”

“…The health care systems across Europe already seem to have taken up this message as numerous hospitals already provide this service to their patients [29]. Alternatively, intensive educational strategies and regular meetings with medical care providers were also shown to be of benefit [25].…”

Persistent Use of Evidence-Based Pharmacotherapy in Heart Failure Is Associated With Improved Outcomes

“…13 This is in accordance with other studies, which have found no association between HF functional class or number of concomitant medications and poorer persistence. 5,14 Comprehensive studies on persistence of pharmacotherapy in HF are sparse. Most studies comprise small selected cohorts with short follow-up, and differences in methods, definitions, and outcomes make direct comparison difficult.…”

Frequency of Recovery and Relapse in Patients With Nonischemic Dilated Cardiomyopathy on Guideline-Directed Medical Therapy

“…21e23 Compliance to long-term b blockers is lesser because of their side effects and range from 77% at 1 year to 53% at 5 years. 21,23,24 Moreover, the dosage of these drugs prescribed is much lower than the recommended target dose. 21,25 In our study, not only the compliance but also the dose of ACE inhibitors or ARBs and b blockers was equally matched in the improved and relapsed groups.…”