scholarly journals The Use of β-Blockers in Heart Failure with Reduced Ejection Fraction

2021 ◽  
Vol 8 (9) ◽  
pp. 101
Author(s):  
Daniele Masarone ◽  
Maria Luigia Martucci ◽  
Vittoria Errigo ◽  
Giuseppe Pacileo
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Arterial Disease ◽  
Reduced Ejection Fraction ◽  
Beneficial Effects ◽  
Diffusion Of Knowledge ◽  
Patients With Heart Failure ◽  
Tailored Approach ◽  
Β Blockers ◽  
Peripheral Arterial

Treatment with β-blockers is the main strategy for managing patients with heart failure and reduced ejection fraction because of their ability to reverse the neurohumoral effects of the sympathetic nervous system, with consequent prognostic and symptomatic benefits. However, to date, they are underused, mainly because of the misconception that hypotension and bradycardia may worsen the haemodynamic status of patients with HFrEF and because of the presence of comorbidities falsely believed to be absolute contraindications to their use. To promote proper use of β-blockers in this article, we review the clinical pharmacology of β-blockers, the evidence of the beneficial effects of these drugs in heart failure with reduced ejection fraction, and the current guidelines for their use in clinical practice and in the presence of comorbidities (e.g., pulmonary disease, diabetes, atrial fibrillation, peripheral arterial disease, etc.). It is hoped that the practical approach discussed in this review will allow for a proper diffusion of knowledge about the correct use of β-blockers and the drug-disease interactions to achieve their increased use and titration, as well as for the selection of a specific agent with a view to a properly tailored approach for HFrEF patients.

scholarly journals Digoxin use and lower risk of 30-day all-cause readmission in older patients with heart failure and reduced ejection fraction receiving β-blockers

2018 ◽  
Vol 41 (3) ◽  
pp. 406-412 ◽  
Author(s):  
Phillip H. Lam ◽  
Poonam Bhyan ◽  
Cherinne Arundel ◽  
Daniel J. Dooley ◽  
Helen M. Sheriff ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Lower Risk ◽  
Older Patients ◽  
Reduced Ejection Fraction ◽  
Patients With Heart Failure ◽  
Β Blockers

Implementation of Guideline-Recommended Therapies for Patients With Heart Failure and Reduced Ejection Fraction: A Regional Arab Middle East Experience

Angiology ◽  
2020 ◽  
Vol 71 (5) ◽  
pp. 431-437
Author(s):  
Mohammad Zubaid ◽  
Wafa Rashed ◽  
Mustafa Ridha ◽  
Nooshin Bazargani ◽  
Adel Hamad ◽  
...  
Keyword(s):  
Heart Failure ◽  
Middle East ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Angiotensin Receptor ◽  
Reduced Ejection Fraction ◽  
Patients With Heart Failure ◽  
Β Blocker ◽  
Β Blockers

We describe the characteristics of ambulatory patients with heart failure with reduced ejection fraction (HFrEF) in the Gulf region (Middle East) and the implementation of guideline-recommended treatments. We included 2427 HFrEF outpatients (mean age 59 ± 13 years, 75% males and median left ventricular ejection fraction [LVEF] of 30%). A high proportion of patients received guideline-recommended medications (angiotensin-converting enzyme inhibitor [ACEI]/angiotensin receptor blocker [ARB]/angiotensin receptor-neprilysin inhibitor [ARNI] 87%, β-blocker 91%, mineralocorticoid antagonist [MRA] 64%). However, only a minority of patients received guideline-recommended target doses (ACEI/ARB/ARNI 13%, β-blocker 27%, and MRA 4.4%). Old age was a significant independent predictor for not prescribing treatment ( P < .001 for ACEI/ARB/ARNI and MRA; and P = .002 for β-blockers). Other independent predictors were chronic kidney disease (for both ACEI/ARB/ARNI and MRA, P < .001) and higher LVEF ( P = .014 for β-blockers and P < .001 for MRA). Patients with HFrEF managed by heart failure specialists more often received recommended target doses of ACEI/ARB/ARNI (40% vs 11%, P < .001) and β-blockers (56% vs 26%, P < .001) compared to those treated by general cardiologists. Although the majority of our patients with HFrEF received guideline-recommended medications, the doses they were prescribed were suboptimal. Understanding the reasons behind this is important for improved practice.

scholarly journals Beta Blockers Up-Titration in Patients with Heart Failure Reduced Ejection Fraction and Cardiac Resynchronization Therapy, a Single Center Study

2019 ◽  
Vol 7 (6) ◽  
pp. 71
Author(s):  
Daniele Masarone ◽  
Marina Verrengia ◽  
Ernesto Ammendola ◽  
Rita Gravino ◽  
Fabio Valente ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Cardiac Resynchronization Therapy ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Reduced Ejection Fraction ◽  
Patients With Heart Failure ◽  
Β Blockers ◽  
Group 2 ◽  
Group 1

Clinical trials have shown the benefits of β-blockers therapy in patients with heart failure reduced ejection fraction. These benefits include improved survival and a reduced need for hospitalization. Cardiac resynchronization therapy has emerged as an essential device-based therapy for symptomatic patients with heart failure reduced ejection fraction despite optimal pharmacologic treatment. The extent to which β-blockers are being utilized in patients receiving cardiac resynchronization therapy is not well known. In this study, we evaluate the possibility of increasing β-blockers doses in an unselected cohort of heart failure reduced ejection patients after cardiac resynchronization therapy capable defibrillator system implantation and the correlation between β-blockers treatments and clinical outcome. Methods and results: Patients with heart failure reduced ejection fraction in β-blockers therapy that underwent cardiac resynchronization therapy capable defibrillator system implantation between July 2008, and December 2016 were enrolled in the study. The β-blockers dose was determined at the time of discharge and during follow-up. Cardiovascular mortality, hospitalization for worsening heart failure or arrhythmic storm and appropriate intervention of the device, were recorded. The study cohort included 480 patients, 289 patients (60.3%) had β-blockers doses equal to the dose before CRT (Group 1), 191 patients (39.7%) had higher β-blockers doses than those before the CRT implant (Group 2). Comparing the two groups, Group 2 have lower cardiovascular mortality, heart failure-related hospitalization, and arrhythmic events than Group 1. Conclusion: After initiating CRT, β-blockers could be safely up-titrated at higher doses with the reduction in mortality, heart failure-related hospitalization, and arrhythmic events.

β-Blockers on Discharge From Acute Atrial Fibrillation Are Associated With Decreased Mortality and Lower Cerebrovascular Accidents in Patients With Heart Failure and Reduced Ejection Fraction

Angiology ◽  
2017 ◽  
Vol 69 (4) ◽  
pp. 316-322 ◽  
Author(s):  
Charbel Abi Khalil ◽  
Mohammad Zubaid ◽  
Nidal Asaad ◽  
Wafa A. Rashed ◽  
Adel Khalifa Hamad ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Emergency Department ◽  
Ejection Fraction ◽  
Transient Ischemic Attacks ◽  
Cerebrovascular Accidents ◽  
Reduced Ejection Fraction ◽  
Patients With Heart Failure ◽  
Β Blockers ◽  
The Cost

The benefits of β-blockers in patients with heart failure (HF) with reduced ejection fraction (HFrEF) and atrial fibrillation (AF) are controversial. The Gulf Survey of Atrial Fibrillation Events was a prospective, multinational, observational registry of consecutive patients with AF recruited from the emergency department (ED). We studied the incidence of 6- and 12-month mortality, hospitalization for HF or AF, and stroke/transient ischemic attacks (TIAs) in patients with HFrEF, in relation to β-blockers on discharge from the ED or the subsequent hospital stay. Of the 344 patients with HFrEF and AF in the GULF-SAFE, 177 patients (53%) were discharged on β-blockers. Mortality was lower in those patients compared with the non-β-blockers group at 6 and 12 months (odds ratios [ORs] 0.31, 95% CI [0.16-0.61]; OR 0.30, 95% CI [0.16-0.55]; P = .001 for both, respectively), so was the risk of stroke/TIAs. However, hospitalizations for AF increased in the β-blockers group. Even after adjustment for several risk variables in 2 different models, the beneficial effect of β-blockers on mortality persisted, at the cost of more hospitalization for AF.

scholarly journals Prevalence of peripheral arterial disease in patients with heart failure with preserved ejection fraction

Clinics ◽  
2019 ◽  
Vol 74 ◽  
Author(s):  
Giuliano Reolon da Cunha ◽  
Roberto José Brugnarotto ◽  
Victória Armendaris El Halal ◽  
Márcio Garcia Menezes ◽  
Eduardo Bartholomay ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Peripheral Arterial Disease ◽  
Arterial Disease ◽  
Preserved Ejection Fraction ◽  
Patients With Heart Failure ◽  
Peripheral Arterial
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