Beta blockers and chronic heart failure patients: prognostic impact of a dose targeted beta blocker therapy vs. heart rate targeted strategy
Background Beta blockers improve survival in patients with chronic systolic heart failure (CHF). Whether physicians should aim for target dose, target heart rate (HR), or both is still under debate. Methods and Results We identified 1,669 patients with systolic CHF due to ischemic heart disease or i...
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| Veröffentlicht in: | Clinical research in cardiology 2018-11, Vol.107 (11), p.1040-1049 |
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| container_title | Clinical research in cardiology |
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| creator | Corletto, Anna Fröhlich, Hanna Täger, Tobias Hochadel, Matthias Zahn, Ralf Kilkowski, Caroline Winkler, Ralph Senges, Jochen Katus, Hugo A. Frankenstein, Lutz |
| description | Background
Beta blockers improve survival in patients with chronic systolic heart failure (CHF). Whether physicians should aim for target dose, target heart rate (HR), or both is still under debate.
Methods and Results
We identified 1,669 patients with systolic CHF due to ischemic heart disease or idiopathic dilated cardiomyopathy from the University Hospital Heidelberg and the Clinic of Ludwigshafen, Germany. All patients were treated with an angiotensin converting enzyme inhibitor or angiotensin receptor blocker and had a history of CHF known for at least 6 months. Target dose was defined as treatment with ≥ 95% of the respective published guideline-recommended dose. Target HR was defined as 51–69 bpm. All-cause mortality during the median follow-up of 42.8 months was analysed with respect to beta blocker dosing and resting HR. 201 (12%) patients met the dose target (group A), 285 (17.1%) met the HR target (group B), 627 (37.6%) met no target (group C), and 556 (33.3%) did not receive beta blockers (Group D). 5-year mortality was 23.7, 22.7, 37.6, and 55.6% for group A, B, C, and D, respectively (
p
< 0.001). Survival for group A patients with a HR ≥ 70 bpm was 28.8% but 14.8% if HR was 50–70 bpm (
p
= 0.054).
Conclusions
Achieving guidelines recommended beta blocker dose or to HR control has a similar positive impact on survival. When on target dose, supplemental HR control additionally improves survival. |
| doi_str_mv | 10.1007/s00392-018-1277-4 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2041631039</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2041631039</sourcerecordid><originalsourceid>FETCH-LOGICAL-c372t-937390c3179f829c64f11d0eebe87c8ce89b214defa1118689423ce3d02f4c173</originalsourceid><addsrcrecordid>eNp1kc9OHSEUh0mjqX_aB-imIXHjZpQD9ALdqWltExM3dk0Y5sy9Y-cOU2BM7jv40DK5t2pMXAHhO78D5yPkC7AzYEydJ8aE4RUDXQFXqpIfyCHoBVRsYfje817LA3KU0j1j34AJ-ZEccKOUlEwdksdLzI7WffB_MSbqhob6VQxD5-kKXcy0dV0_RaSjyx0OOX2nYwzLIaRckG49Op9paKmjTUhIs4tLzNjQ-lUszSuMbtzQh3S2S40uv4JTns_LzSey37o-4efdekz-_Pxxd_Wrurm9_n11cVN5oXiujFDCMC9AmVZz4xeyBWgYYo1aee1Rm5qDbLB1AGUG2kguPIqG8VZ6UOKYnG5zy1f-TZiyXXfJY9-7AcOULGcSFqLMyhT05A16H6Y4lNfNVCE0cFko2FI-hpQitnaM3drFjQVmZ1V2q8oWVXZWZeear7vkqV5j81zx300B-BZI5WpYYnxp_X7qE0x1n44</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2040398124</pqid></control><display><type>article</type><title>Beta blockers and chronic heart failure patients: prognostic impact of a dose targeted beta blocker therapy vs. heart rate targeted strategy</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>Corletto, Anna ; Fröhlich, Hanna ; Täger, Tobias ; Hochadel, Matthias ; Zahn, Ralf ; Kilkowski, Caroline ; Winkler, Ralph ; Senges, Jochen ; Katus, Hugo A. ; Frankenstein, Lutz</creator><creatorcontrib>Corletto, Anna ; Fröhlich, Hanna ; Täger, Tobias ; Hochadel, Matthias ; Zahn, Ralf ; Kilkowski, Caroline ; Winkler, Ralph ; Senges, Jochen ; Katus, Hugo A. ; Frankenstein, Lutz</creatorcontrib><description>Background
Beta blockers improve survival in patients with chronic systolic heart failure (CHF). Whether physicians should aim for target dose, target heart rate (HR), or both is still under debate.
Methods and Results
We identified 1,669 patients with systolic CHF due to ischemic heart disease or idiopathic dilated cardiomyopathy from the University Hospital Heidelberg and the Clinic of Ludwigshafen, Germany. All patients were treated with an angiotensin converting enzyme inhibitor or angiotensin receptor blocker and had a history of CHF known for at least 6 months. Target dose was defined as treatment with ≥ 95% of the respective published guideline-recommended dose. Target HR was defined as 51–69 bpm. All-cause mortality during the median follow-up of 42.8 months was analysed with respect to beta blocker dosing and resting HR. 201 (12%) patients met the dose target (group A), 285 (17.1%) met the HR target (group B), 627 (37.6%) met no target (group C), and 556 (33.3%) did not receive beta blockers (Group D). 5-year mortality was 23.7, 22.7, 37.6, and 55.6% for group A, B, C, and D, respectively (
p
< 0.001). Survival for group A patients with a HR ≥ 70 bpm was 28.8% but 14.8% if HR was 50–70 bpm (
p
= 0.054).
Conclusions
Achieving guidelines recommended beta blocker dose or to HR control has a similar positive impact on survival. When on target dose, supplemental HR control additionally improves survival.</description><identifier>ISSN: 1861-0684</identifier><identifier>EISSN: 1861-0692</identifier><identifier>DOI: 10.1007/s00392-018-1277-4</identifier><identifier>PMID: 29774407</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Adrenergic beta-Antagonists - therapeutic use ; Angiotensin-converting enzyme inhibitors ; Beta blockers ; Cardiology ; Cardiomyopathy ; Carvedilol - therapeutic use ; Cause of Death - trends ; Coronary artery disease ; Dilated cardiomyopathy ; Dosage ; Enzyme inhibitors ; Female ; Follow-Up Studies ; Germany - epidemiology ; Heart diseases ; Heart failure ; Heart Failure, Systolic - drug therapy ; Heart Failure, Systolic - mortality ; Heart Failure, Systolic - physiopathology ; Heart rate ; Heart Rate - drug effects ; Heart Rate - physiology ; Humans ; Ischemia ; Male ; Medical personnel ; Medicine ; Medicine & Public Health ; Metoprolol - therapeutic use ; Middle Aged ; Mortality ; Original Paper ; Patients ; Peptidyl-dipeptidase A ; Physicians ; Prognosis ; Retrospective Studies ; Stroke Volume - drug effects ; Stroke Volume - physiology ; Survival ; Survival Rate - trends ; Time Factors</subject><ispartof>Clinical research in cardiology, 2018-11, Vol.107 (11), p.1040-1049</ispartof><rights>Springer-Verlag GmbH Germany, part of Springer Nature 2018</rights><rights>Clinical Research in Cardiology is a copyright of Springer, (2018). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c372t-937390c3179f829c64f11d0eebe87c8ce89b214defa1118689423ce3d02f4c173</citedby><cites>FETCH-LOGICAL-c372t-937390c3179f829c64f11d0eebe87c8ce89b214defa1118689423ce3d02f4c173</cites><orcidid>0000-0001-7216-1004</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00392-018-1277-4$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00392-018-1277-4$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29774407$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Corletto, Anna</creatorcontrib><creatorcontrib>Fröhlich, Hanna</creatorcontrib><creatorcontrib>Täger, Tobias</creatorcontrib><creatorcontrib>Hochadel, Matthias</creatorcontrib><creatorcontrib>Zahn, Ralf</creatorcontrib><creatorcontrib>Kilkowski, Caroline</creatorcontrib><creatorcontrib>Winkler, Ralph</creatorcontrib><creatorcontrib>Senges, Jochen</creatorcontrib><creatorcontrib>Katus, Hugo A.</creatorcontrib><creatorcontrib>Frankenstein, Lutz</creatorcontrib><title>Beta blockers and chronic heart failure patients: prognostic impact of a dose targeted beta blocker therapy vs. heart rate targeted strategy</title><title>Clinical research in cardiology</title><addtitle>Clin Res Cardiol</addtitle><addtitle>Clin Res Cardiol</addtitle><description>Background
Beta blockers improve survival in patients with chronic systolic heart failure (CHF). Whether physicians should aim for target dose, target heart rate (HR), or both is still under debate.
Methods and Results
We identified 1,669 patients with systolic CHF due to ischemic heart disease or idiopathic dilated cardiomyopathy from the University Hospital Heidelberg and the Clinic of Ludwigshafen, Germany. All patients were treated with an angiotensin converting enzyme inhibitor or angiotensin receptor blocker and had a history of CHF known for at least 6 months. Target dose was defined as treatment with ≥ 95% of the respective published guideline-recommended dose. Target HR was defined as 51–69 bpm. All-cause mortality during the median follow-up of 42.8 months was analysed with respect to beta blocker dosing and resting HR. 201 (12%) patients met the dose target (group A), 285 (17.1%) met the HR target (group B), 627 (37.6%) met no target (group C), and 556 (33.3%) did not receive beta blockers (Group D). 5-year mortality was 23.7, 22.7, 37.6, and 55.6% for group A, B, C, and D, respectively (
p
< 0.001). Survival for group A patients with a HR ≥ 70 bpm was 28.8% but 14.8% if HR was 50–70 bpm (
p
= 0.054).
Conclusions
Achieving guidelines recommended beta blocker dose or to HR control has a similar positive impact on survival. When on target dose, supplemental HR control additionally improves survival.</description><subject>Adrenergic beta-Antagonists - therapeutic use</subject><subject>Angiotensin-converting enzyme inhibitors</subject><subject>Beta blockers</subject><subject>Cardiology</subject><subject>Cardiomyopathy</subject><subject>Carvedilol - therapeutic use</subject><subject>Cause of Death - trends</subject><subject>Coronary artery disease</subject><subject>Dilated cardiomyopathy</subject><subject>Dosage</subject><subject>Enzyme inhibitors</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Germany - epidemiology</subject><subject>Heart diseases</subject><subject>Heart failure</subject><subject>Heart Failure, Systolic - drug therapy</subject><subject>Heart Failure, Systolic - mortality</subject><subject>Heart Failure, Systolic - physiopathology</subject><subject>Heart rate</subject><subject>Heart Rate - drug effects</subject><subject>Heart Rate - physiology</subject><subject>Humans</subject><subject>Ischemia</subject><subject>Male</subject><subject>Medical personnel</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Metoprolol - therapeutic use</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Original Paper</subject><subject>Patients</subject><subject>Peptidyl-dipeptidase A</subject><subject>Physicians</subject><subject>Prognosis</subject><subject>Retrospective Studies</subject><subject>Stroke Volume - drug effects</subject><subject>Stroke Volume - physiology</subject><subject>Survival</subject><subject>Survival Rate - trends</subject><subject>Time Factors</subject><issn>1861-0684</issn><issn>1861-0692</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp1kc9OHSEUh0mjqX_aB-imIXHjZpQD9ALdqWltExM3dk0Y5sy9Y-cOU2BM7jv40DK5t2pMXAHhO78D5yPkC7AzYEydJ8aE4RUDXQFXqpIfyCHoBVRsYfje817LA3KU0j1j34AJ-ZEccKOUlEwdksdLzI7WffB_MSbqhob6VQxD5-kKXcy0dV0_RaSjyx0OOX2nYwzLIaRckG49Op9paKmjTUhIs4tLzNjQ-lUszSuMbtzQh3S2S40uv4JTns_LzSey37o-4efdekz-_Pxxd_Wrurm9_n11cVN5oXiujFDCMC9AmVZz4xeyBWgYYo1aee1Rm5qDbLB1AGUG2kguPIqG8VZ6UOKYnG5zy1f-TZiyXXfJY9-7AcOULGcSFqLMyhT05A16H6Y4lNfNVCE0cFko2FI-hpQitnaM3drFjQVmZ1V2q8oWVXZWZeear7vkqV5j81zx300B-BZI5WpYYnxp_X7qE0x1n44</recordid><startdate>20181101</startdate><enddate>20181101</enddate><creator>Corletto, Anna</creator><creator>Fröhlich, Hanna</creator><creator>Täger, Tobias</creator><creator>Hochadel, Matthias</creator><creator>Zahn, Ralf</creator><creator>Kilkowski, Caroline</creator><creator>Winkler, Ralph</creator><creator>Senges, Jochen</creator><creator>Katus, Hugo A.</creator><creator>Frankenstein, Lutz</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M7Z</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-7216-1004</orcidid></search><sort><creationdate>20181101</creationdate><title>Beta blockers and chronic heart failure patients: prognostic impact of a dose targeted beta blocker therapy vs. heart rate targeted strategy</title><author>Corletto, Anna ; Fröhlich, Hanna ; Täger, Tobias ; Hochadel, Matthias ; Zahn, Ralf ; Kilkowski, Caroline ; Winkler, Ralph ; Senges, Jochen ; Katus, Hugo A. ; Frankenstein, Lutz</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c372t-937390c3179f829c64f11d0eebe87c8ce89b214defa1118689423ce3d02f4c173</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Adrenergic beta-Antagonists - therapeutic use</topic><topic>Angiotensin-converting enzyme inhibitors</topic><topic>Beta blockers</topic><topic>Cardiology</topic><topic>Cardiomyopathy</topic><topic>Carvedilol - therapeutic use</topic><topic>Cause of Death - trends</topic><topic>Coronary artery disease</topic><topic>Dilated cardiomyopathy</topic><topic>Dosage</topic><topic>Enzyme inhibitors</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Germany - epidemiology</topic><topic>Heart diseases</topic><topic>Heart failure</topic><topic>Heart Failure, Systolic - drug therapy</topic><topic>Heart Failure, Systolic - mortality</topic><topic>Heart Failure, Systolic - physiopathology</topic><topic>Heart rate</topic><topic>Heart Rate - drug effects</topic><topic>Heart Rate - physiology</topic><topic>Humans</topic><topic>Ischemia</topic><topic>Male</topic><topic>Medical personnel</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Metoprolol - therapeutic use</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Original Paper</topic><topic>Patients</topic><topic>Peptidyl-dipeptidase A</topic><topic>Physicians</topic><topic>Prognosis</topic><topic>Retrospective Studies</topic><topic>Stroke Volume - drug effects</topic><topic>Stroke Volume - physiology</topic><topic>Survival</topic><topic>Survival Rate - trends</topic><topic>Time Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Corletto, Anna</creatorcontrib><creatorcontrib>Fröhlich, Hanna</creatorcontrib><creatorcontrib>Täger, Tobias</creatorcontrib><creatorcontrib>Hochadel, Matthias</creatorcontrib><creatorcontrib>Zahn, Ralf</creatorcontrib><creatorcontrib>Kilkowski, Caroline</creatorcontrib><creatorcontrib>Winkler, Ralph</creatorcontrib><creatorcontrib>Senges, Jochen</creatorcontrib><creatorcontrib>Katus, Hugo A.</creatorcontrib><creatorcontrib>Frankenstein, Lutz</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biochemistry Abstracts 1</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical research in cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Corletto, Anna</au><au>Fröhlich, Hanna</au><au>Täger, Tobias</au><au>Hochadel, Matthias</au><au>Zahn, Ralf</au><au>Kilkowski, Caroline</au><au>Winkler, Ralph</au><au>Senges, Jochen</au><au>Katus, Hugo A.</au><au>Frankenstein, Lutz</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Beta blockers and chronic heart failure patients: prognostic impact of a dose targeted beta blocker therapy vs. heart rate targeted strategy</atitle><jtitle>Clinical research in cardiology</jtitle><stitle>Clin Res Cardiol</stitle><addtitle>Clin Res Cardiol</addtitle><date>2018-11-01</date><risdate>2018</risdate><volume>107</volume><issue>11</issue><spage>1040</spage><epage>1049</epage><pages>1040-1049</pages><issn>1861-0684</issn><eissn>1861-0692</eissn><abstract>Background
Beta blockers improve survival in patients with chronic systolic heart failure (CHF). Whether physicians should aim for target dose, target heart rate (HR), or both is still under debate.
Methods and Results
We identified 1,669 patients with systolic CHF due to ischemic heart disease or idiopathic dilated cardiomyopathy from the University Hospital Heidelberg and the Clinic of Ludwigshafen, Germany. All patients were treated with an angiotensin converting enzyme inhibitor or angiotensin receptor blocker and had a history of CHF known for at least 6 months. Target dose was defined as treatment with ≥ 95% of the respective published guideline-recommended dose. Target HR was defined as 51–69 bpm. All-cause mortality during the median follow-up of 42.8 months was analysed with respect to beta blocker dosing and resting HR. 201 (12%) patients met the dose target (group A), 285 (17.1%) met the HR target (group B), 627 (37.6%) met no target (group C), and 556 (33.3%) did not receive beta blockers (Group D). 5-year mortality was 23.7, 22.7, 37.6, and 55.6% for group A, B, C, and D, respectively (
p
< 0.001). Survival for group A patients with a HR ≥ 70 bpm was 28.8% but 14.8% if HR was 50–70 bpm (
p
= 0.054).
Conclusions
Achieving guidelines recommended beta blocker dose or to HR control has a similar positive impact on survival. When on target dose, supplemental HR control additionally improves survival.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>29774407</pmid><doi>10.1007/s00392-018-1277-4</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0001-7216-1004</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1861-0684 |
| ispartof | Clinical research in cardiology, 2018-11, Vol.107 (11), p.1040-1049 |
| issn | 1861-0684 1861-0692 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2041631039 |
| source | MEDLINE; SpringerLink Journals - AutoHoldings |
| subjects | Adrenergic beta-Antagonists - therapeutic use Angiotensin-converting enzyme inhibitors Beta blockers Cardiology Cardiomyopathy Carvedilol - therapeutic use Cause of Death - trends Coronary artery disease Dilated cardiomyopathy Dosage Enzyme inhibitors Female Follow-Up Studies Germany - epidemiology Heart diseases Heart failure Heart Failure, Systolic - drug therapy Heart Failure, Systolic - mortality Heart Failure, Systolic - physiopathology Heart rate Heart Rate - drug effects Heart Rate - physiology Humans Ischemia Male Medical personnel Medicine Medicine & Public Health Metoprolol - therapeutic use Middle Aged Mortality Original Paper Patients Peptidyl-dipeptidase A Physicians Prognosis Retrospective Studies Stroke Volume - drug effects Stroke Volume - physiology Survival Survival Rate - trends Time Factors |
| title | Beta blockers and chronic heart failure patients: prognostic impact of a dose targeted beta blocker therapy vs. heart rate targeted strategy |
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