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Is target dose the treatment target? Uptitrating beta-blockers for heart failure in the elderly

Item Type:Article
Title:Is target dose the treatment target? Uptitrating beta-blockers for heart failure in the elderly
Creators Name:Gelbrich, G. and Edelmann, F. and Inkrot, S. and Lainscak, M. and Apostolovic, S. and Neskovic, A.N. and Waagstein, F. and Loeffler, M. and Anker, S.D. and Dietz, R. and Duengen, H.D.
Abstract:BACKGROUND: Guideline-recommended beta-blocker (BB) target doses for patients with chronic heart failure can often not be reached. This secondary analysis of the CIBIS-ELD trial was carried out to better understand reasons for not achieving target doses. METHODS: Changes in heart rate (HR) and other parameters during a 12-week up-titration period in 302 BB naïve patients were evaluated in the subgroups achieving 12.5, 25, 50, and 100% of the target dose (groups 1, 2, 3, and 4, respectively). RESULTS: Achieved doses predominantly depended on baseline HR (means 68, 74, 76, and 84bpm in groups 1-4, respectively, P<0.001). HR was consistently reduced with each dose level to 65, 63, and 62bpm in groups 1-3 and to 71bpm in group 4 (P<0.001). When adjusted for baseline, HR reduction achieved in group 3 was better than in group 4 (difference -5.4bpm, P<0.05). More patients in groups 3/4 than in groups 1/2 improved in NYHA class (P=0.01). NTproBNP increased by 38% in group 4 (P<0.01) but not in the others (P<0.05 between groups). Changes in blood pressure, six-minute walk distance and self-rated health were comparable in all groups. CONCLUSIONS: The desired effect of HR reduction appears to be a predominant limitation for BB up-titration. Vice versa, achieving the target dose may be a sign of insufficient response rather than successful treatment. In view of these results and the well-known importance of HR for survival, not target doses, but HR control should be given priority in BB treatment for heart failure.
Keywords:Heart Failure, Beta-Blocker, Target Dose, Heart Rate, Guidelines, Elderly Patients
Source:International Journal of Cardiology
Page Range:160-166
Date:23 February 2012
Official Publication:https://doi.org/10.1016/j.ijcard.2011.11.018
PubMed:View item in PubMed

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