Abstract 4858: Patterns in Beta Blockerw use ith Cardiac Resynchronization Therapy: Insights from the COMPANION Study

Abstract

Cardiac resynchronization therapy (CRT) is typically delivered in addition to background heart failure medications that include beta blockers (BB). Since CRT devices also provide rate support, it was hypothesized that CRT may influence BB use post-implant. We sought to compare BB use in the treatment arms of the COMPANION study, which randomized patients (pts) to optimal pharmacological therapy (OPT) alone or in combination with CRT with or without a defibrillator. The database was analyzed retrospectively for a 12-month period post-randomization. BB dosages were evaluated at the 12-month visit with the last follow-up (FU) visit used for those without 12 month FU data. Pts with no FU data were excluded. Dosages are expressed in carvedilol equivalents. The median dose between the two treatment arms were compared as well as up/down titration rates. Of 1520 pts randomized, 1376 (91%) were followed for at least three months and 689 (50%) were followed for at least 12 months. The median dose was 25 mg/day for both groups at baseline (p=0.93) and again at 12 months (p=0.53). BB use between arms is characterized in the tables below: In this retrospective analysis of the COMPANION trial, there was no significant association between treatment arm and BB drug use. Up/down-titration rates and median dosages were virtually identical between the two arms. COMPANION did not require investigators to increase BB dosage; accordingly, a prospective study would be needed to definitively determine if BB dosage can be titrated more aggressively with CRT.