Composite Outcome of All-Cause Mortality and Hospitalization among Chronic Heart Failure Patients Receiving Different Doses of Beta-Blockers
Article Sidebar
Main Article Content
Abstract
Objective: To compare effectiveness of high, medium and low dose beta-blockers (carvedilol and bisoprolol) on one-year composite outcome of all-cause mortality and all-cause hospitalization (COACMH) in chronic heart failure patients. Methods: This retrospective cohort study collected data from medical records of chronic heart failure patients with ICD10: I500 receiving care from outpatient department of Maharaj Nakhonsithammarat hospital from January 1, 2013 to December 31, 2018. The study measured one-year COACMH of patients with various doses of beta-blockers. Results: Of the total of 542 patients in the study, only 3.3% of subjects reached target dose of beta blockers. Those receiving high dose of the drugs (higher than 50% of target dose) showed a significantly lower one-year COACMH rate than those with low dose group (lower than 25% of target dose) (HR=0.63, 95%CI 0.41–0.95, P=0.03). Conclusion: Patients with high dose of beta blockers had a significantly lower one-year COACMH rate than those with low dose group. Therefore, doses of the drugs should be titrated in all patients to reach maximum tolerated dose if there are no contraindication in order to achieve maximum effectiveness.
Article Details
ผลการวิจัยและความคิดเห็นที่ปรากฏในบทความถือเป็นความคิดเห็นและอยู่ในความรับผิดชอบของผู้นิพนธ์ มิใช่ความเห็นหรือความรับผิดชอบของกองบรรณาธิการ หรือคณะเภสัชศาสตร์ มหาวิทยาลัยสงขลานครินทร์ ทั้งนี้ไม่รวมความผิดพลาดอันเกิดจากการพิมพ์ บทความที่ได้รับการเผยแพร่โดยวารสารเภสัชกรรมไทยถือเป็นสิทธิ์ของวารสารฯ
References
Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJS, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure of the European Society of Cardiology (ESC) developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 37: 2129-200.
Cowie MR MA, Wood DA, Poole-Wilson PA, Sutton GC, Grobbee DE. The epidemiology of heart failure. Eur Heart J 1997; 18: 208-25.
Ariyachaipanich A, Krittayaphong R, Kunjara N, Yingchoncharoen T, Buakhamsri A, Suvachittanont N. Heart Failure Council of Thailand (HFCT) 2019 Heart Failure Guideline: Guideline development. J Med Assoc Thai 2019; 102: 231-9.
Laothavorn P, Hengrussamee K, Kanjanavanit R, Moleerergpoom W, Laorakpongse D, Pachirat O, et al. Thai Acute Decompensated Heart Failure Registry (Thai ADHERE). CVD Prev Control 2010; 5: 89-95.
CIBIS-II C. The Cardiac Insufficiency Bisoprolol Study II (CIBIS-II): a randomised trial. Lancet. 1999; 353: 9-13.
Packer M, Fowler MB, Roecker EB, Coats AJ, Katus HA, Krum H, et al. Effect of carvedilol on the morbidity of patients with severe chronic heart failure: results of the carvedilol prospective randomized cumulative survival (COPERNICUS) study. Circulation. 2002; 106: 2194-9.
Packer M CA, Fowler MB, Katus HA, Krum H, Mohacsi P, et al. Effect of carvedilol on survival in severe chronic heart failure. N Engl J Med 2001; 344: 1651-8.
Nabeta T, Inomata T, Iida Y, Ikeda Y, Iwamoto-Ishida M, Ishii S, et al. Prognostic significance of beta-blocker up-titration in conjunction with cardiac resynchronization therapy in heart failure management. Heart Vessels. 2016; 31: 1109-16.
Xu Y, Shi Y, Zhu Z, Cui C, Li B, Chen F, et al. Prognosis of patients with heart failure and reduced ejection fraction in China. Exp Ther Med. 2013; 6:1437-42.
Komajda M, Anker SD, Cowie MR, Filippatos GS, Mengelle B, Ponikowski P, et al. Physicians' adherence to guideline-recommended medications in heart failure with reduced ejection fraction: data from the QUALIFY global survey. Eur J Heart Fail. 2016; 18: 514-22.
Simon T, Mary-Krause M, Funck-Brentano C, Lechat P, Jaillon P. Bisoprolol dose–response relationship in patients with congestive heart failure: a subgroup analysis in the cardiac insufficiency bisoprolol study (CIBIS II). Eur Heart J 2003; 24: 552-9.
Fiuzat M, Wojdyla D, Pina I, Adams K, Whellan D, O'Connor CM. Heart rate or beta-blocker dose? association with outcomes in ambulatory heart failure patients with systolic dysfunction: Results from the HF-ACTION Trial. JACC Heart Fail 2016; 4: 109-15.
Ajam T, Ajam S, Devaraj S, Fudim M, Kamalesh M. Effect on mortality of higher versus lower beta-blocker (metoprolol succinate or carvedilol) dose in patients with heart failure. Am J Cardiol 2018; 122: 994-8.
Hori M, Sasayama S, Kitabatake A, Toyo-oka T, Handa S, Yokoyama M, et al. Low-dose carvedilol improves left ventricular function and reduces cardiovascular hospitalization in Japanese patients with chronic heart failure: the Multicenter Carvedilol Heart Failure Dose Assessment (MUCHA) trial. Am Heart J. 2004; 147: 324-30.
Okamoto H, Hori M, Matsuzaki M, Tsutsui H, Yamazaki T, Nagai R, et al. Minimal dose for effective clinical outcome and predictive factors for responsiveness to carvedilol: Japanese chronic heart failure (J-CHF) study. Int J Cardiol. 2013; 164: 238-44.
Liao KM, Lin TY, Huang YB, Kuo CC, Chen CY. The evaluation of beta-adrenoceptor blocking agents in patients with COPD and congestive heart failure: a nationwide study. Int J Chron Obstruct Pulmon Dis. 2017; 12: 2573-81.
Bristow MR GE, Abraham WT, Adams KF, Fowler MB, Hershberger RE, et al. Carvedilol produces dose-related improvements in left ventricular function and survival in subjects with chronic heart failure. Circulation. 1996; 94: 2807–16.
Ouwerkerk W, Voors AA, Anker SD, Cleland JG, Dickstein K, Filippatos G, et al. Determinants and clinical outcome of uptitration of ACE-inhibitors and beta-blockers in patients with heart failure: a prospective European study. Eur Heart J 2017; 38: 1883-90.
