Use of bisoprolol in heart failure. The BISOCOR observational study

The benefits of beta blockers in heart failure are highly dependent on dosage. This study aimed to analyze the degree of concordance between targeted (CIBIS II) and achieved doses of bisoprolol in a group of patients with stable heart failure on conventional treatment. We also evaluated functional parameters, adverse effects and the reasons for withdrawal or drop-out. The study group consisted of 334 patients with stable systolic heart failure who were receiving conventional treatment. Treatment with bisoprolol was initiated according to current guidelines (starting dose 1.25 mg/day, with weekly increments to 5 mg/day, and then increments every four weeks to a targeted dosis of 10 mg/day). The main endpoint was the comparison between targeted dose and dose reached at each follow-up. Secondary endpoints were quality of life assessment (Minnesota Living with Heart Failure Questionnaire), functional status (New York Heart Association), ejection fraction change, and side effects during the 9-month follow-up period. Thirty-four (10%) patients did not finish the study: 1 because of sudden death, 2 because of surgery, and 31 because of side effects. 63% of the patients attained the maximum targeted dose; the mean dose at the end of follow-up was 8.5 mg. Functional status, quality of life and ejection fraction improved significantly between the beginning and the end of the study. Only 4 patients had severe adverse effects. This is the first study in Spain to show that bisoprolol can be used effectively at the maximum recommended doses, for the outpatient treatment of heart failure.