Heart failure and atrial fibrillation. Prognosis with beta blocker and digoxin alone or in combination

2008 ◽  
Vol 7 ◽  
pp. 161-162
Author(s):  
L FAUCHIER ◽  
B RAUZY ◽  
E NONIN ◽  
L GORIN ◽  
O MARIE ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Beta Blocker

P3793Spironolactone in patients with permanent atrial fibrillation, possible heart failure protective potential

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
R Dabrowski ◽  
T Chwyczko ◽  
I Kowalik ◽  
E Smolis-Bak ◽  
A Borowiec ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Beta Blocker ◽  
Interstitial Fibrosis ◽  
Randomized Study ◽  
Treated Group ◽  
Control Treatment ◽  
Permanent Atrial Fibrillation ◽  
Minute Walk

Abstract Background Atrial fibrillation (AF) promotes electrical, neurohormonal and structural remodeling of atria and ventricles. Long lasting AF leads to atrial interstitial fibrosis, apoptosis, loss of myofibrils and finally to heart failure (HF). Purpose The aim of the study was impact of aldosterone antagonist, spironolactone, on exercise tolerance and neurohormonal activity in patients with permanent AF without symptoms of HF. Methods In prospective, randomized study patients with permanent AF at least for 1 year, no signs and symptoms of HF and stable clinical condition were included. Patients were randomized to: beta-blocker plus spironolactone (dose: 25 mg) treatment and rate-control treatment with only beta-blocker. Propranolol, metoprolol and bisoprolol were used, doses were adjusted to achieve resting heart rate 60–80/min. Ergospirometry (CPX) and 6-minute walk (6-MWT) tests were performed during separate days. Results Study group consisted of 49 patients, 69% men, mean age 62.1±9.6 without structural and chronic active diseases, mean time of arrhythmia was 5.5 years, Q1: 2, Q3: 8 years. Follow-up was 11.2 months. All patients were treated with beta-blockers, 27 patients were treated with 25 mg spironolactone. Surprisingly physical capacity in 6-minute walk test (6-MWT) in studied patients was not significantly reduced in comparison with values ranges for healthy volunteers. After 11.2 months follow-up significantly longer exercise time (433±113 vs. 367±162 sec, p<0.05) and lower maximal HR (159±25 vs. 165±22 beats/min, p<0.0550) were observed in spironolactone treated group. Other CPX variables did not differ significantly between groups after 11,2 months: VO2: 20.7±5.1 vs. 20.1±4.8 [ml/kg/min]; VO2 as % of normal value: 78.4±15.2 vs. 76.8±15.2; O2 pulse: 12±2.8 vs. 12.7±3.6 [ml/beat]; AT: 1.4±0.3, 1.6±0.5 [L/min]; VE: 74.9±20.0, 72.6±17.9 [L/min]. All spirometric variables worsened after 11.2 months: VC: 4.3±1.1 vs. 3.8±0.8 [L], p<0.0005, FVC: 4.2±1.1 vs. 3.8±1.0 p<0.005 [L], FEV1: 3.1±0.8 vs. 2.8±0.7 [L], p<0.01. In spironolactone treated group after 11.2 months BNP concentrations were significantly lower: Q1: 54, Q2: 83, Q3: 100 vs. Q1: 42, Q2: 93; Q3: 184 ng/L (p=0.025) and aldosterone levels were markedly increased: Q1: 216, Q2: 266; Q3:443 vs. Q1: 169; Q2: 228; Q3:294 ng/dL (p=0.0007). Conclusions In patients with permanent atrial fibrillation cardiopulmonary exercise responses were markedly abnormal, but exercise capacity was increased after spironolactone treatment. Deterioration of spirometry results might be due to beta-blocker treatment. In spironolactone treated group BNP levels were significantly lower what may correspond to its heart failure protective activity.

Beta-blocker is Effective in Reducing Cardiovascular Events in Patients with Chronic Heart Failure Complicated by Atrial Fibrillation

2005 ◽  
Vol 11 (9) ◽  
pp. S294
Author(s):  
Nobuyuki Shiba ◽  
Tomohiro Tada ◽  
Tsuyoshi Shinozaki ◽  
Koji Fukuda ◽  
Jun Takahashi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Chronic Heart Failure ◽  
Beta Blocker ◽  
Cardiovascular Events

1412Effect of beta-blocker dose on the prognosis in chronic heart failure patients depending on the presence of atrial fibrillation. Data from FAR NHL (FARmacology and NeuroHumoraL activation) registry

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
K Labr ◽  
J Spinar ◽  
J Parenica ◽  
L Spinarova ◽  
F Malek ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Chronic Heart Failure ◽  
Primary Endpoint ◽  
Beta Blocker ◽  
Low Dose ◽  
Beta Blockers ◽  
High Dose ◽  
Heart Failure Patients ◽  
Medium Dose

Abstract Background Beta-blockers (BB) decrease morbidity and mortality in heart failure patients and are part of the first line treatment together with inhibitors of angiotensin converting enzyme. New metaanalysis from year 2014 of main BB studies in chronic heart failure showed no benefit of BB in patients with atrial fibrillation (AF). Methods 1088 at least one month stable chronic heart failure patients with ejection fraction <50% were included in FAR NHL (FARmacology and NeuroHumoraL activation) registry. Three centers with speciality in heart failure in the Czech Republic were participating from November 2014 to December 2015. Results 80% patients were male with median age 66 years. Aetiology of heart failure was in 49.4% ischemic heart disease, in 42.3% dilated cardiomyopathy, in 0.5% hypertrophy cardiomyopathy. From those receiving beta-blockers 20% received low dose similar to the starting dose, 57% medium dose and 17% high dose which was set as the target BB dose. Nearly 93.8% of patients received BB. But only 17.0% received the high dose of BB. 6.2% of patients were not treated by BB at all. One third of patients (34.5%) had atrial fibrillation in medical history or newly recorded on electrocardiogram. Patients with AF were much older (median 63 vs. 70 years, respectively; p<0.001), had higher heart rate (72 vs. 74 /min; p<0.006) and were also in higher class of NYHA (New York Heart Association; p=0.005). The primary endpoint was set as all cause death, mechanical circulatory support implantation, orthotopic heart transplantation or hospitalization for acute heart failure. Patients with AF survived without primary endpoint in 70.6%, patients without AF in 78.8% (p=0.005) even after age standardization. There was significantly different survival according to dose of beta-blocker, the higher was dose of BB, the higher was survival. Patients with no beta-blocker survived without primary endpoint in 63.9%, with low dose survived in 72.6%, medium dose in 77.0% and with high dose in 80.9%. We devided FAR NHL patients into two groups according to atrial fibrillation. Patients without AF had the better survival without primary endpoint. The higher dose of beta-blockers they got, the better survival they had (69.5%, 76.7%, 78.9%, 85.1%; p=0.007). Also patients with AF had better survival without primary endpoint, the higher dose of beta-blocker they got, the higher was their survival without endpoitnt (56.0%, 63.6%, 73.0%, 75.8%; p=0.007). Conclusion In FAR NHL registry of stable chronic heart failure patietnts was one third of patients with atrial fibrillation. Nearly 94% of patients received beta-blocker. But only 17% received the target dose. Pacients even with or without atrial fibrillation had the significantly better survival without primary endpoint the higher was the dose of beta-blocker.

EFFECT OF PHARMACOTHERAPY ON COLLAGEN METABOLISM IN PATIENTS WITH HEART FAILURE WITH MIDDLE RANGE EJECTION FRACTION OF SENILE AGE

2021 ◽  
pp. 956-963
Author(s):  
О. А. Осипова ◽  
Е. В. Гостева ◽  
А. Н. Ильницкий ◽  
К. И. Прощаев ◽  
О. А. Рождественская ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Chronic Heart Failure ◽  
Ejection Fraction ◽  
Myocardial Fibrosis ◽  
Coronary Disease ◽  
Beta Blocker ◽  
Systolic Dysfunction ◽  
Collagen Metabolism ◽  
Middle Range

Особый интерес представляет изучение механизмов развития ХСН, особенно c промежуточной ФВ (ХСНпрФВ), у больных старческого возраста. В условиях ХСН многократно возрастает значимость развития фиброза миокарда, приводящего к необратимой дисфункции, что способствует дальнейшему прогрессированию ХСН. Фибрилляция предсердий является дополнительным фактором, способствующим систолической дисфункции ЛЖ. Цель исследования -изучение влияния β-блокаторов на изменения маркеров фиброза у больных старческого возраста с ХСНпрФВ, в том числе и с фибрилляцией предсердий. Обследованы 104 больных ХСНпрФВ ишемического генеза II ФК по классификации NYHA, средний возраст - 78,4±3,2 года. Через 12 мес нами выявлено достоверное снижение уровня матриксной металлопротеиназы 1-го типа, 9-го типа (ММП-1, ММП9), тканевого ингибитора ММП-1 (ТИМП-1), а также соотношения ММП-1/ТИМП-1, ММП-9/ТИМП-1 у больных старческого возраста, имеющих ХСНпрФВ ишемического генеза, в том числе и с фибрилляцией предсердий (ММП-1, ММП-9, ТИМП-1, ММП-9/ТИМП-1), принимавших в качестве β-блокатора небиволол. У больных, принимавших бисопролол, достоверных изменений изучаемых показателей не выявлено (кроме ММП-9). Изменения метаболизма коллагена обусловливают восстановление функции миокарда после терапии β-блокатором небивололом у пациентов с ХСНпрФВ, в том числе и при фибрилляции предсердий. Сывороточные маркеры оборота коллагена могут служить неинвазивным методом документирования и мониторинга как степени, так и механизмов фиброза миокарда у больных ХСНпрФВ ишемического генеза, в том числе и на фоне фибрилляции предсердий. Of particular interest is the study of the mechanisms of development of chronic heart failure, especially with middle range ejection fraction (HFmrEF). In conditions of HF, the significance of the development of myocardial fibrosis increases many times, leading to irreversible dysfunction, which contributes to the further progression of HF. Atrial fibrillation is an additional factor contributing to systolic dysfunction of the left ventricle. The purpose of this study was to study the effect of beta-blockers on changes in fibrosis markers in senile patients with HF, including those with AF. 104 patients with HF, coronary disease of functional class II were examined according to the classification of NYHA, the average age was 78,4±3,2 years. After 12 months, we found a significant decrease in the level of matrix metalloproteinase-type 1, -type 9 (MMP-1, MMP-9), tissue inhibitor MMP-1 (TIMP-1), as well as the ratio of MMP-1/TIMP-1, MMP-9/TIMP-1 in senile patients with HF, including those with atrial fibrillation who took nebivolol as a beta-blocker. While in patients who took bisoprolol, no significant changes in the studied parameters were detected (except for MMP-9). Changes in collagen metabolism cause the restoration of myocardial function after therapy with the beta-blocker nebivolol in patients with chronic heart failure with an middle range ejection fraction, including atrial fibrillation. Serum markers of collagen turnover can serve as a noninvasive method for documenting and monitoring both the degree and mechanisms of myocardial fibrosis in patients with HF, coronary disease, including in the presence of AF.

scholarly journals Beta-blockers or Digoxin for Atrial Fibrillation and Heart Failure?

2016 ◽  
Vol 2 (1) ◽  
pp. 35 ◽  
Author(s):  
Laurent Fauchier ◽  
Guillaume Laborie ◽  
Nicolas Clementy ◽  
Dominique Babuty ◽  
◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Beta Blocker ◽  
Rate Control ◽  
Beta Blockers ◽  
Therapeutic Option ◽  
Systolic Dysfunction ◽  
Ventricular Rate ◽  
Channel Blockers ◽  
Reduced Ejection Fraction

In patients with atrial fibrillation (AF) and heart failure (HF) with or without systolic dysfunction, either rhythm control or rate control is an acceptable primary therapeutic option. If a rate control strategy is chosen, treatment with a beta-blocker is almost always required to achieve rate control. Adequate ventricular rate control is usually a resting rate of less than 100 beats per minute, but lower resting rates may be appropriate. Non-dihydropyridine calcium channel blockers are often contraindicated when AF is associated with HF with systolic dysfunction. There have been recent debates on a possible reduced efficacy of beta-blockers as well as safety issues with digoxin when treating HF patients with AF. The benefit of beta-blockers on survival may be lower in patients with HF with reduced ejection fraction when AF is present. Digoxin does not improve survival but may help to obtain satisfactory rate control in combination with a beta-blocker. Digoxin may be useful in the presence of hypotension or an absolute contraindication to beta-blocker treatment.

scholarly journals Treatment optimization of beta-blockers in chronic heart failure therapy

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Yirga Legesse Niriayo ◽  
Solomon Weldegebreal Asgedom ◽  
Gebre Teklemariam Demoz ◽  
Kidu Gidey
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Heart Disease ◽  
Chronic Heart Failure ◽  
Ischemic Heart Disease ◽  
Beta Blocker ◽  
Beta Blockers ◽  
Evidence Based ◽  
Heart Failure Therapy ◽  
Evidence Based Guidelines

Abstract Although evidence based guidelines recommend optimal use of beta blockers in all patients with chronic heart failure unless contraindicated, they are often underutilized and/or prescribed below the recommended dosage in the majority of patients with heart failure. To our knowledge, however, the optimal use of beta-blockers in chronic heart failure is not investigated in Ethiopia. Therefore, the aim of our study was to investigate the utilization and optimization of beta blockers in the management of patients with chronic heart failure in Ethiopia. A prospective observational study was conducted among ambulatory patients with chronic heart failure in Ethiopia. We included adult patients with a diagnosis of heart failure with a baseline left ventricular ejection fraction < 40% who had been on follow-up for at least 6 months. Patients were recruited into the study during their appointment for medication refilling using simple random sampling technique. All patients were followed for at least 6 months to determine the optimal use of beta blockers. The optimal use of beta blockers was determined according to evidence based guidelines. After explaining the purpose of the study, we obtained written informed consent from all participants. Data were collected through patient interview and review of patients’ medical records. Binary logistic regression analysis was performed to identify factors associated with utilization of beta blockers. A total of 288 patients were included in the study. Out of the total, 67% of the patients were receiving beta blockers. Among the patients who received beta blockers, 34.2% were taking guideline recommended beta blockers while 65.8% were taking atenolol, which is not guideline recommended beta blocker. Among the patients who received guideline recommended beta blockers, only 3% were taking optimal dose. Prior hospitalization [Adjusted Odds ratio (AOR) 0.38, 95% confidence interval (CI) 0.19–0.76], dose of furosemide > 40 mg (AOR 0.39, 95% CI 0.20–0.76), ischemic heart disease (AOR 3.27, 95% CI 1.66–6.45), atrial fibrillation (AOR 4.41, 95% CI 1.38–14.13) were significantly associated with the utilization of beta-blockers. Despite proven benefit, beta blockers were not optimally used in most of the participants in this study. The presence of ischemic heart disease and atrial fibrillation were positively associated with the utilization of beta blockers while hospitalization and higher diuretic dose were negatively associated with the utilization of beta blockers. Clinicians should attempt to use evidence based beta blockers at guideline recommended target doses that have been shown to have morbidity and mortality benefit in chronic heart failure. Moreover, more effort needs to be done to minimize the potentially modifiable risk factors for underutilization of beta blocker in chronic heart failure therapy.

Is Achieved Heart Rate a Surrogate Maker during Titration of Beta-blocker in Heart Failure with Atrial Fibrillation?

2013 ◽  
Vol 19 (8) ◽  
pp. S29
Author(s):  
Naoko Kato ◽  
Koichiro Kinugawa ◽  
Teruhiko Imamura ◽  
Hironori Muraoka ◽  
Shun Minatsuki ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Heart Rate ◽  
Beta Blocker
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