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Cited by 36Heart Failure Treatment and ManagementHeart rate and cardiovascular healthCardiovascular Function and Risk Factors

Role of High-Dose Beta-Blockers in Patients with Heart Failure with Preserved Ejection Fraction and Elevated Heart Rate

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Lam, Phillip H., Gupta, Neha, Dooley, Daniel J., Singh, Steven, Deedwania, Prakash, Zile, Michael R., Bhatt, Deepak L., Morgan, Charity J. +3 more·2018·The American Journal of Medicine
DOI 10.1016/j.amjmed.2018.07.008PMC PMC10463568
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Abstract

Background Beta-blockers in high target doses are recommended for heart failure with reduced ejection fraction (HFrEF) but not for preserved ejection fraction (HFpEF). Treatment benefits are often more pronounced in high-risk subgroups, and patients with HFpEF with heart rate ≥70 beats per minute have emerged as such a high-risk subgroup. We examined the associations of high-dose beta-blocker use with outcomes in these patients. Methods Of the 8462 hospitalized patients with heart failure with ejection fraction ≥50% in the Medicare-linked Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF) registry, 5422 had a discharge heart rate ≥70 beats per minute. Of these, 4537 had no contraindications to beta-blocker use, of which 2797 (2592 with dose data) received prescriptions for beta-blockers. Of the 2592, 730 received high-dose beta-blockers, defined as atenolol ≥100 mg/day, carvedilol ≥50 mg/day, metoprolol tartrate or succinate ≥200 mg/day, or bisoprolol ≥10 mg/day, and 1740 received no beta-blockers. Using propensity scores for the receipt of high-dose beta-blockers, we assembled a matched cohort of 1280 patients, balanced on 58 characteristics. Results All-cause mortality occurred in 63% and 68% of matched patients receiving high-dose beta-blocker vs no beta-blocker, respectively, during 6 years (median, 2.8) of follow-up (hazard ratio, 0.86; 95% confidence interval, 0.75-0.98; P = .027). The hazard ratios (95% confidence intervals) for all-cause readmission and the combined endpoint of all-cause readmission or all-cause mortality associated with high-dose beta-blocker use were 0.90 (0.81-1.02) and 0.89 (0.80-1.00), respectively. Conclusions In patients with HFpEF and heart rate ≥70 beats per minute, high-dose beta-blocker use was associated with a significantly lower risk of death. Future randomized controlled trials are needed to examine this association.

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  • The average dose for each beta-blocker agent was significantly lower than the maximum therapeutic dose.

    “It should also be noted that the average dose for each agent was significantly lower than the maximum therapeutic dose [43,44,45].”

    From Beta-Blocker-Related Atrioventricular Conduction Disorders—A Single Tertiary Referral Center Experience (2022) · cites this paper as [44]

    The Methods section (“Discharge Use of Beta-Blockers”; page unavailable) reports that only 15%–49% of recipients of each listed agent met the study’s high-dose threshold, supporting the general point that lower doses were common. It does not report average doses for each agent, identify those thresholds as maximum therapeutic doses, or test whether the averages were significantly lower than those maxima. (LLM, conf=0.82)

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Authors
Lam, P. H., Gupta, N., Dooley, D. J., Singh, S., Deedwania, P., Zile, M. R., Bhatt, D. L., Morgan, C. J., Pitt, B., Fonarow, G. C., & Ahmed, A.
Affiliations
  • Brigham and Women's Hospital (US)
  • Georgetown University (US)
  • University of California, San Francisco (US)
  • Medical University of South Carolina (US)
  • University of Alabama at Birmingham (US)
  • University of Michigan (US)
  • University of California, Los Angeles (US)
  • George Washington University (US)
Corresponding author
Ahmed, Ali
ORCID
Venue
The American Journal of Medicine
Publisher
Elsevier BV
Published
2018-12
Volume
131
Issue
12
Pages
1473-1481
ISSN
0002-9343 (ISSN-L)
DOI
10.1016/j.amjmed.2018.07.008
PMC
PMC10463568
OpenAlex
W2887547688
Cited by
36
References
2
Citations by year
2026: 2 · 2025: 4 · 2024: 6 · 2023: 5 · 2022: 2 · 2021: 4 · 2020: 7 · 2019: 5 · 2018: 1
FWCI
3.22
Type
journal article
Language
en
Open access
Licence
Locations
  • The American Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
Funders
National Institutes of Health (R01-HL085561, R01-HL085561-S, and R01-HL097047)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart rate and cardiovascular health
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
Keywords
heart failure with preserved ejection fraction, heart rate, all-cause mortality, hospital readmission, atenolol, carvedilol, metoprolol, bisoprolol, heart failure pharmacotherapy, high-risk subgroups, propensity score matching, Medicare beneficiaries, beta-blocker dose
MeSH terms
Adrenergic beta-Antagonists, Aged, Aged, 80 and over, Dose-Response Relationship, Drug, Heart Failure, Heart Rate, Humans, Stroke Volume, Logistic Models, Propensity Score

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