Optimised Beta Blocker Therapy in Heart Failure
Optimised Beta Blocker Therapy in Heart Failure
From the 172 referrals, 125 (72.6%) were for up-titration of existing therapy, and 47 (27.3%) for initiation of beta blockers. The baseline demographics are illustrated in Table 1.
The patients referred for initiation of beta blocker therapy included subjects that had previously failed initiation of beta blockers. In this challenging cohort of patients, we were able to successfully initiate beta blockers in 27/47 patients, while 20 patients were intolerant. Intolerance to beta blocker initiation was only accepted after failing the protocol-guided system and after discussion with the MDT. Causes for beta blocker intolerances included: severe and limiting hypotension 48%; intractable lethargy 26%; and hospitalisation with severe reversible airways disease 26%. Seven subjects initially on a beta blocker were unable to tolerate long-term therapy.
Overall, 145/172 (84.3%) patients could tolerate beta blocker therapy and 27 (15.7%) patients could not tolerate beta blockers. In total, 57/172 (33.1%) subjects could tolerate maximum dose and 110/172 (65.0%) could tolerate ≥50% maximum recommended doses of beta blockers. The haemodynamic profiles before and after optimisation are illustrated in Table 2.
Of the 172 patients, 72 (41.9%) had a resting heart rate ≥70 bpm. From this group of patients, 26/72 (36.1%) achieved their target dose of beta blockers, 36/72 (50%) ≥50% of maximum dose of beta blocker and 17/72 (23.6%) were unable to tolerate beta blockers After filtering the data, 31 (30.7%) patients in sinus rhythm, ejection fraction ≤35% had suboptimal HR control (Figure 1).
(Enlarge Image)
Figure 1.
Flow chart of heart failure characteristics after optimisation of medication
Results
From the 172 referrals, 125 (72.6%) were for up-titration of existing therapy, and 47 (27.3%) for initiation of beta blockers. The baseline demographics are illustrated in Table 1.
The patients referred for initiation of beta blocker therapy included subjects that had previously failed initiation of beta blockers. In this challenging cohort of patients, we were able to successfully initiate beta blockers in 27/47 patients, while 20 patients were intolerant. Intolerance to beta blocker initiation was only accepted after failing the protocol-guided system and after discussion with the MDT. Causes for beta blocker intolerances included: severe and limiting hypotension 48%; intractable lethargy 26%; and hospitalisation with severe reversible airways disease 26%. Seven subjects initially on a beta blocker were unable to tolerate long-term therapy.
Overall, 145/172 (84.3%) patients could tolerate beta blocker therapy and 27 (15.7%) patients could not tolerate beta blockers. In total, 57/172 (33.1%) subjects could tolerate maximum dose and 110/172 (65.0%) could tolerate ≥50% maximum recommended doses of beta blockers. The haemodynamic profiles before and after optimisation are illustrated in Table 2.
Of the 172 patients, 72 (41.9%) had a resting heart rate ≥70 bpm. From this group of patients, 26/72 (36.1%) achieved their target dose of beta blockers, 36/72 (50%) ≥50% of maximum dose of beta blocker and 17/72 (23.6%) were unable to tolerate beta blockers After filtering the data, 31 (30.7%) patients in sinus rhythm, ejection fraction ≤35% had suboptimal HR control (Figure 1).
(Enlarge Image)
Figure 1.
Flow chart of heart failure characteristics after optimisation of medication
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