Abstract
Background: All guidelines by experts agree that Beta-Blockers (BB) should be used for patients with systolic heart failure (SHF) to improve survival. Despite recommendations, the dosages of BBs prescribed are frequently less than 50% of target dose. Under dosing is suggested by doses <50% of target dose and/or Sinus Rate (SR) >70 bpm. Chronic Obstructive Pulmonary Disease (COPD) is the most common reason for omitting and under-dosing BB therapy. This led to the question how patients with SHF are without COPD being treated with BBs.
Methods/Results: A retrospective chart review of SHF patients without COPD was made at the time of admission to Charleston Area Medical Center from January 1, 2010 through September 30, 2016. Dosages of BBs on admission, SR on admission and discharge, other cardiac medications, echocardiogram ejection fraction, and EKG data were recorded. Of the 144 HF patients without COPD, 124 (86.1%) were taking BBs, 69 (55.6%) carvedilol; 40 (32.2%) metoprolol succinate; 12 (9.7%) metoprolol tartrate; 3 (2.4%) other and 18(12.5%) were not taking BBs. Mean dose of carvedilol at admission was 18.7±14.8 mg (target dose 50 mg); mean dose of metoprolol succinate was 52.8±43.8mg (target dose 200 mg). Mean sinus rate (not atrial paced or atrial f ibrillation) at admission and discharge were 85.3±18.3 bpm and 76.0±16.6 bpm, respectively, for those whose BB dose did not change. 74% of patients had admission SR >70 bpm.
Conclusion: While almost all patients with diagnosed SHF are appropriately being prescribed BBs, a large percentage was not titrated up to the target doses established in the guidelines. Inappropriate dosing of BBs could potentially be responsible for worsening outcomes and overutilization of more expensive alternative treatments to adequately suppress SR.
Citation
Trump T, Robinson J, Syed Q, Kostelic P, Kerr K, Memon A, et al. Dose of Beta Blocker and Sinus Rate Achieved for Patients with Systolic Heart Failure without COPD. SM J Cardiolog and Cardiovasc Disord. 2018; 4(1): 1020.