Abstract P113: Use of Guideline Recommended Therapies for Heart Failure in Outpatient Settings Among Medicare Beneficiaries

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
Lisa D DiMartino ◽  
Alisa Shea ◽  
Adrian F Hernandez ◽  
Lesley H Curtis
Keyword(s):  
Heart Failure ◽  
Beta Blocker ◽  
Ace Inhibitor ◽  
Beta Blockers ◽  
Multivariable Analysis ◽  
Community Dwelling ◽  
Drug Coverage ◽  
Self Report ◽  
Medicare Beneficiaries ◽  
Over Time

Background: Most information about the use of guideline recommended therapies for heart failure (HF) is based on what occurs at discharge following an inpatient stay. Using a nationally representative, community-dwelling sample of elderly Medicare beneficiaries, we examined how use of angiotensin-converting enzyme (ACE) inhibitor, angiotensin-receptor blocker (ARB), and beta-blocker therapies has changed over time and factors associated with their use. Methods: We used data from the Medicare Current Beneficiary Survey Cost and Use files matched with Medicare claims to identify beneficiaries for whom a diagnosis of HF was reported from January 1, 2000-December 31, 2004. Medications prescribed during the calendar year of cohort entry were obtained from patient self-report. We used descriptive statistics to examine prescription medication use over time. Multivariable logistic regression was used to explore the relationship between use of an ACE inhibitor/ARB or beta blocker and patient demographics. Results: There were 2,689 unweighted, or 8,288,306 weighted, elderly, community-dwelling Medicare beneficiaries with HF identified. Between 2000 and 2004, the reported use of ARBs increased from 12% (unweighted, 88/725) to 19% (unweighted, 82/421), while use of beta-blockers increased from 30% (unweighted, 215/725) to 41% (unweighted, 170/421). Use of ACE inhibitors remained constant at 45% (unweighted 2000, 329/725; unweighted 2004, 192/421). In multivariable analysis, beneficiaries reporting any prescription drug coverage were 32% (95%CI=1.09-1.59) more likely to have filled a prescription for an ACE inhibitor/ARB and 26% (95%CI=1.03-1.53) more likely to have filled a prescription for a beta-blocker. Compared to beneficiaries diagnosed with HF in 2000, beneficiaries diagnosed in 2004 were 38% (95%CI=1.06-1.79) more likely to have filled a prescription for an ACE inhibitor/ARB and 62% (95%CI=1.23-2.13) more likely to have filled a prescription for a beta-blocker. Conclusion: Although use of guideline recommended therapies for HF has increased over time, their use remains suboptimal. Further efforts are necessary in order to ensure all Medicare beneficiaries have adequate drug coverage for these therapies.

P3517Failure to achieve adequate heart rate control in women during therapy optimization

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
V Kutyifa ◽  
J W Erath ◽  
A Burch ◽  
B Assmus ◽  
D Bondermann ◽  
...  
Keyword(s):  
Heart Failure ◽  
Heart Rate ◽  
Beta Blocker ◽  
Rate Control ◽  
Beta Blockers ◽  
Heart Rate Control ◽  
Blocker Therapy ◽  
Cardioverter Defibrillator ◽  
Beta Blocker Therapy ◽  
The Mean

Abstract Background Previous studies highlighted the importance of adequate heart rate control in heart failure patients, and suggested under-treatment with beta-blockers especially in women. However, data on women achieving effective heart rate control during beta-blocker therapy optimization are lacking. Methods The wearable cardioverter defibrillator (WCD) allows continuous monitoring of heart rate (HR) trends during WCD use. In the current study, we assessed resting HR trends (nighttime: midnight-7am) in women, both at the beginning of WCD use and at the end of WCD use to assess the adequacy of beta-blockade following a typical 3 months of therapy optimization with beta-blockers. An adequate heart rate control was defined as having a nighttime HR <70 bpm at the end of the 3 months. Results There were a total of 21,453 women with at least 30 days of WCD use (>140 hours WCD use on the first and last week). The mean age was 67 years (IQR 58–75). The mean nighttime heart rate was 72 bpm (IQR 65–81) at the beginning of WCD use, that decreased to 68 bpm (IQR 61–76) at the end of WCD use with therapy optimization. Women had an insufficient heart rate control with resting heart rate ≥70 bpm in 59% at the beginning of WCD use that decreased to 44% at the end of WCD use, but still remained surprisingly high. Interestingly, there were 21% of the women starting with HR ≥70 bpm at the beginning of use (BOU) who achieved adequate heart rate control by the end of use (EOU). Interestingly, 6% of women with adequate heart rate control at the start of therapy optimization ended up having higher heart rates >70 bpm at the end of the therapy optimization time period (Figure). Figure 1 Conclusions A significant proportion of women with heart failure and low ejection fraction do not reach an adequate heart rate control during the time of beta blocker initiation/titration. The wearble cardioverter defibrillator is a monitoring device that has been demonstrated in this study to appropriately identify patients with inadequate heart rate control at the end of the therapy optimization period. The WCD could be utilized to improve management of beta-blocker therapy in women and improve the achievement of adequate heart rate control in women.

Abstract 302: The PAT Ratio is Reduced by Beta-blockers

2017 ◽  
Vol 37 (suppl_1) ◽  
Author(s):  
Ueda Tomohiro
Keyword(s):  
Brachial Artery ◽  
Beta Blocker ◽  
Vascular Function ◽  
Beta Blockers ◽  
Multivariable Analysis ◽  
Control Group ◽  
Peripheral Arterial Tonometry ◽  
Result Show ◽  
Peripheral Arterial ◽  
And Control

Background: Flow-mediated dilatation (FMD) of the brachial artery and Peripheral arterial tonometry (PAT) are both methods for assessing endothelial vascular function. FMD measures predominantly nitric oxide mediated vasodilation whereas PAT measures a more complex range of mechanisms. The recent study showed that the sympathetic nervous system plays a significant role in this response. Methods: The study involved 176 subjects (mean age66 ±12 years). Based on the medication of beta-blockers, they were divided into 2 groups: beta-blocker group (n=37) and control group (n=139). Flow mediated vasodilatation (FMD) and nitroglycerine-induced vasodilatation (NID) in the brachial artery was measured by using UNEXEF18G (UNEX CO, Japan), and nitroglycerin mediated vasodilatation (NMD) was used as a control test for FMD. At the same time, PAT ratio was measured by using Endo-PAT 2000 (Itamar Medical, Israel) Results: PAT ratio was significantly impaired in beta-blocker group compared to that in control group (1.5±0.4% vs. 1.9±0.6%, respectively; P<0.05). However, FMD and NMD had no deference in both groups. Multivariable analysis revealed that blood sugar and medication of beta-blockers were independent variables for PAT ratio. Conclusion: These result show that beta-blockers is associated with a tendency towards reduced PAT ratio. PAT needs to be further studied, including the assessment of non-endothelial factor

Abstract 13135: Starting Beta-blockers in Hypertension is Followed by Excess Loop Diuretic Use: Beta-blocker Induced Heart Failure?

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Daniel N Silverman ◽  
Jeanne d de Lavallaz ◽  
Timothy B Plante ◽  
Margaret M Infeld ◽  
Markus Meyer
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Beta Blocker ◽  
Antihypertensive Medication ◽  
Temporal Relationship ◽  
Loop Diuretic ◽  
Beta Blockers ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction

Introduction: Recent investigation has identified that discontinuation of beta-blockers in subjects with normal left ventricular ejection fraction (LVEF) leads to a reduction in natriuretic peptide levels. We investigated whether a similar trend would be seen in a hypertension clinical trial cohort. Methods: In 9,012 subjects hypertensive subjects without a history of symptomatic heart failure, known LVEF <35% or recent heart failure hospitalization enrolled in the Systolic Blood Pressure Intervention Trial (SPRINT), we compared incidence of loop diuretic initiation and time to initiation following start of a new anti-hypertensive medication. The categorical relationship (new antihypertensive class followed by loop-diuretic use) and temporal relationship (time to loop diuretic initiation) were each analyzed. The categorical relationship was assessed using a Pearson’s chi-squared test and the temporal relationship using a Wilcoxon rank sum test. Bonferroni-corrected p-values were utilized for all comparisons. Results: Among the 9,012 subjects analyzed, the incidence of anti-hypertensive initiation and loop diuretic initiation was greatest following start of a beta-blocker (16.6%) compared with other antihypertensive medication classes (calcium channel blocker 13.8%, angiotensin converting enzyme-inhibitor/angiotensin receptor blocker 12.9% and thiazide diuretic 10.2%; p<0.001). In addition, the median time between starting a new antihypertensive medication and loop diuretic was the shortest for beta-blockers and longest for thiazides (both p <0.01). No significant differences in renal function were identified between groups. Conclusion: Compared to other major classes of hypertensive agents, starting beta-blockers was associated with more common and earlier initiation of a loop diuretics in a population without heart failure at baseline. This finding may suggest beta-blocker induced heart failure in a population with a predominantly normal ejection fraction.

scholarly journals The Impact of Treatment with Beta-Blockers upon Mortality in Chronic Heart Failure Patients

2016 ◽  
Vol 4 (1) ◽  
pp. 94-97 ◽  
Author(s):  
Borjanka Taneva ◽  
Daniela Caparoska
Keyword(s):  
Heart Failure ◽  
Relative Risk ◽  
Chronic Heart Failure ◽  
Beta Blocker ◽  
Cardiovascular Mortality ◽  
Conventional Therapy ◽  
Therapy Group ◽  
Beta Blockers ◽  
Control Group ◽  
Heart Failure Patients

BACKGROUND: Besides the conventional therapy for heart failure, the diuretics, cardiac glycosides and ACE-inhibitors, current pharmacotherapy includes beta-blockers, mainly because of their pathophysiological mechanisms upon heart remodeling.AIM: The study objective was to assess the cardiovascular mortality in the beta-blocker therapy group and to correlate it with the mortality in the control group as well as to correlate the combined outcome of death and/or hospitalization for cardiovascular reason between the two groups.               MATERIALS AND METHODS: The study included 113 chronic heart failure patients followed up for a period of 18 months. The therapy group received conventional therapy plus the target dose of beta blockers, and the control group received the conventional therapy only. The therapy group was divided in three separate subgroups in terms of the type of beta-blocker (Metoprolol subgroup, Bisoprolol and Carvedilol subgroup). To compare the mortality and the combined outcome, the RRR (relative risk reduction) and NNT (number needed to treat) were used, as well as the survival analysis by Kaplan-Meier.RESULTS: The results showed the following: in regards of the cardiovascular mortality, the relative risk for death in the therapy group was 34%, which, though statistically not significant, is of great clinical significance. In regards of the combined outcome (death and/or number of hospitalizations) the results showed a RRR of 40% in the therapy group compared to the control group, which is statistically highly significant.CONCLUSION: The study confirmed that patients with stable chronic heart failure, treated with optimal doses of beta-blockers, show a significant reduction of the risk from death as well as combined outcome (death and/or number of hospitalizations).

Abstract 17200: Plasma BNP Declines in the First Two Years After Transplant and is Elevated at the Time of Treated Rejection

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_1) ◽  
Author(s):  
Tom J Valikodath ◽  
Neal Jorgensen ◽  
Erin Albers ◽  
Borah Hong ◽  
Joshua Friedland-Little ◽  
...  
Keyword(s):  
Heart Failure ◽  
Natriuretic Peptide ◽  
Ventricular Dysfunction ◽  
Multivariable Analysis ◽  
Wall Stress ◽  
Ventricular Wall ◽  
The Relationship ◽  
Pediatric Recipients ◽  
Over Time

Introduction: Plasma B-type natriuretic peptide (BNP) is a biomarker used to diagnose and monitor ventricular dysfunction and heart failure. However, the response of the allograft to produce BNP from ventricular wall stress and inflammation may be different, particularly in an understudied population such as pediatric recipients. Hypothesis: BNP levels decrease over time after transplant as the allograft recovers; but BNP will be higher during rejection. Methods: Enrolled all heart recipients from January 2007 to December 2016. Rejection surveillance included serial echocardiography, annual biopsy, and BNP q 1-3 months. Rejection is defined as requiring augmentation of immunosuppression from biopsy grade ≥ 2R or ≥ pAMR2 or from clinical diagnosis. Results: Among 114 patients studied, 60% were male with age at transplant 5.8 ± SD 6.5 yrs. Follow-up was 3.7 ± 2.7 yrs and 37 patients (32%) experienced 75 episodes of rejection. A total of 8358 BNP samples were obtained. BNP decreased linearly after transplant leveling off after 2 years (Fig 1). BNP was 671 ± 1115 (n=75) at rejection vs. 187 ± 423 pg/mL (n=501) without rejection confirmed by biopsy. By multivariable analysis, Ln BNP was associated with rejection (RR 1.56; 95% CI 1.35-1.80). Figure 2 shows the relationship between change in BNP and risk of rejection. Multivariable longitudinal Cox proportional model incorporating BNPs leading to 1 st rejection showed Ln BNP to be associated with rejection (HR 2.22; 95% CI 1.53-3.23, p<0.001). Conclusion: BNP continues to decrease in the 1 st 2 years after transplant. At rejection, BNP is elevated, and this test can be further developed to screen for rejection.

P1666Do beta-blockers increase the risk for hospitalizations in heart failure with preserved ejection fraction? A secondary analysis of beta-blocker use in the TOPCAT trial

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
D N Silverman ◽  
T B Plante ◽  
M I Infeld ◽  
S P Juraschek ◽  
G Dougherty ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Beta Blocker ◽  
Proportional Hazards ◽  
Beta Blockers ◽  
Secondary Analysis ◽  
Cox Proportional Hazards ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Reduced Ejection Fraction

Abstract Background The use of beta-blockers for treatment of heart failure (HF) with a reduced ejection fraction (EF) is unequivocally beneficial, but their role in the treatment of preserved EF (HFpEF) remains unclear. Purpose In a contemporary HFpEF cohort, we sought to assess the association of HF hospitalizations and the use of beta-blockers in patients with an EF above and below 50%. Methods The TOPCAT trial tested spironolactone vs. placebo among patients with HFpEF, including some with mild reductions in EF between 45–50%. The primary outcome was a composite of cardiovascular (CV) mortality, aborted cardiac arrest, or HF hospitalizations. Medication use, including beta-blockers, was reported at each visit and hospitalization. In the 1,761 participants from the Americas, we compared the association of beta-blocker use (vs. no use) and HF hospitalization or CV mortality using Cox proportional hazards models adjusted for baseline demographics, history of myocardial infarction, atrial fibrillation, chronic obstructive pulmonary disease, asthma, and hypertension. The analyses were repeated in the EF strata ≥50% and <50%. Results Among patients included in the current analysis (mean age 72 years, 50% female, 78% white), 1,496/1,761 (85%) received beta-blockers and 1,566/1,761 (89%) had an EF ≥50%. HF hospitalizations and CV mortality occurred in 399/1,761 (23%) and 223/1,761 (13%) of participants, respectively. Beta-blocker use was associated with an increase in risk of HF hospitalization among patients with preserved EF ≥50% [HR 1.56, (95% CI 1.09–2.24), p=0.01] and was associated with a reduction in risk of hospitalization in patients with an EF <50% [HR 0.42, (95% CI 0.18- 0.99), p<0.05]. We found a significant interaction for EF threshold and beta-blocker use on incident HF hospitalizations (p=0.01). There were no differences in CV mortality. Figure 1. Kaplan Meier incidence plots Conclusions Beta-blocker use was associated with an increase in HF hospitalizations in patients with HFpEF (EF≥50%) but did not affect CV mortality. Further research is needed to confirm these findings and elucidate causality.

scholarly journals SO057BETA-BLOCKERS ARE ASSOCIATED WITH REDUCED MORTALITY IN PATIENTS WITH HEART FAILURE WITH REDUCED EJECTION FRACTION AND ADVANCED CHRONIC KIDNEY DISEASE: COHORT STUDY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Edouard L Fu ◽  
Alicia Uijl ◽  
Friedo W Dekker ◽  
Lars H Lund ◽  
Gianluigi Savarese ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Ejection Fraction ◽  
Beta Blocker ◽  
Beta Blockers ◽  
Advanced Chronic Kidney Disease ◽  
Reduced Ejection Fraction ◽  
Patients With Heart Failure ◽  
All Cause Mortality

Abstract Background and Aims Beta-blockers reduce mortality and morbidity in patients with heart failure (HF) with reduced ejection fraction (HFrEF). However, patients with advanced chronic kidney disease (CKD) were underrepresented in landmark trials. We evaluated if beta-blockers are associated with improved survival in patients with HFrEF and advanced CKD. Method We identified 3906 persons with an ejection fraction &lt;40% and advanced CKD (eGFR &lt;30 mL/min/1.73m2) enrolled in the Swedish Heart Failure Registry during 2001-2016. The associations between beta-blocker use, 5-year all-cause mortality, and the composite of time to cardiovascular (CV) mortality/first HF hospitalization were assessed by multivariable Cox regression. Analyses were adjusted for 36 variables, including demographics, laboratory measures, comorbidities, medication use, medical procedures, and socioeconomic status. To assess consistency, the same analyses were performed in a positive control cohort of 12,673 patients with moderate CKD (eGFR &lt;60-30 mL/min/1.73m2). Results The majority (89%) of individuals with HFrEF and advanced CKD received treatment with beta-blockers. Median (IQR) age was 81 (74-86) years, 36% were women and median eGFR was 26 (20-28) mL/min/173m2. During 5 years of follow-up, 2086 (53.4%) individuals had a subsequent HF hospitalization, and 2954 (75.6%) individuals died, of which 2089 (70.1%) due to cardiovascular causes. Beta-blocker use was associated with a significant reduction in 5-year all-cause mortality [adjusted hazard ratio (HR) 0.86; 95% confidence interval (CI) 0.76-0.96)] and CV mortality/HF hospitalization (HR 0.87; 95% CI 0.77-0.98). The magnitude of the associations between beta-blocker use and outcomes was similar to that observed for HFrEF patients with mild/moderate CKD, with adjusted HRs for all-cause mortality and CV mortality/HF hospitalization of 0.85 (95% CI 0.78-0.91) and 0.88 (95% CI 0.82-0.96), respectively. Conclusion Despite lack of trial evidence, the use of beta-blockers in patients with HFrEF and advanced CKD was high in routine Swedish care, and was independently associated with reduced mortality to the same degree as HFrEF with moderate CKD.

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