Abstract
Background: Randomized trials have demonstrated the efficacy of beta-blockers (BBs) in heart failure (HF) patients. We sought to assess the impact of BBs on long-term outcome; in particular, we assessed the association between outcome and BB dose and discharge heart rate. Methods and Results: Prescriptions for dispensed medication and outcomes were identified from a prospective, single-institution HF registry. Long-term prognosis was compared between users and non-users of BBs. BB users were further divided into 2 groups based on dose (full and non-full dose) and discharge heart rate (70 bpm was significantly associated with impaired long-term outcome (HR = 1.872, P = 0.04). Conclusions: Optimizing heart rate, rather than maximizing BB dose, appears to be an appropriate treatment strategy for the beta-sensitive Japanese population.
Highlights
Evidence from clinical trials supports the use of pharmacological therapies in heart failure (HF) patients in order to improve their long-term outcome [1]
Randomized trials have demonstrated the efficacy of beta-blockers (BBs) in heart failure (HF) patients
In addition to angiotensin-converting enzyme inhibitors (ACEi), aldosterone receptor antagonists, and angiotensin II receptor blockers, randomized trials have demonstrated the favorable effect of selective adrenergic receptor antagonists such as bisoprolol [2,3,4,5], sustained-release metoprolol [6,7], and carvedilol [8,9,10,11,12,13] in HF with reduced left ventricular systolic function
Summary
Evidence from clinical trials supports the use of pharmacological therapies in heart failure (HF) patients in order to improve their long-term outcome [1]. Ethnical variability in the use of and response to pharmacological therapies has been reported. It remains unclear how the therapeutic guidelines for HF, which are based on trials mainly conducted on Caucasian populations, can be implemented for ethnically different populations, Asian HF patients. There are significant racial differences in response to BBs, and limited studies have been performed on Asian populations [16]. Seow et al reported high mortality in multiethnic Southeast Asian patients (67% in 5 years) despite high use of ACEi (79%), albeit with low use of BBs (5%) [18]. We analyzed the effects of BB dose and discharge heart rate
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