Anna Corletto1, Hanna Fröhlich1, Tobias Täger1, Matthias Hochadel2, Ralf Zahn2, Caroline Kilkowski2, Ralph Winkler2, Jochen Senges3, Hugo A Katus1, Lutz Frankenstein4. 1. Department of Cardiology, Angiology, and Pulmology, University of Heidelberg, Im Neuenheimer Feld 410, 69221, Heidelberg, Germany. 2. Medizinische Klinik B-Abteilung für Kardiologie, Klinikum der Stadt Ludwigshafen GmbH, Ludwigshafen am Rhein, 67059, Germany. 3. Stiftung Institut für Herzinfarktforschung, Bremserstraße 79, 67063, Ludwigshafen am Rhein, Germany. 4. Department of Cardiology, Angiology, and Pulmology, University of Heidelberg, Im Neuenheimer Feld 410, 69221, Heidelberg, Germany. lutz.frankenstein@med.uni-heidelberg.de.
Abstract
BACKGROUND: Beta blockers improve survival in patients with chronic systolic heart failure (CHF). Whether physicians should aim for target dose, target heart rate (HR), or both is still under debate. METHODS AND RESULTS: We identified 1,669 patients with systolic CHF due to ischemic heart disease or idiopathic dilated cardiomyopathy from the University Hospital Heidelberg and the Clinic of Ludwigshafen, Germany. All patients were treated with an angiotensin converting enzyme inhibitor or angiotensin receptor blocker and had a history of CHF known for at least 6 months. Target dose was defined as treatment with ≥ 95% of the respective published guideline-recommended dose. Target HR was defined as 51-69 bpm. All-cause mortality during the median follow-up of 42.8 months was analysed with respect to beta blocker dosing and resting HR. 201 (12%) patients met the dose target (group A), 285 (17.1%) met the HR target (group B), 627 (37.6%) met no target (group C), and 556 (33.3%) did not receive beta blockers (Group D). 5-year mortality was 23.7, 22.7, 37.6, and 55.6% for group A, B, C, and D, respectively (p < 0.001). Survival for group A patients with a HR ≥ 70 bpm was 28.8% but 14.8% if HR was 50-70 bpm (p = 0.054). CONCLUSIONS: Achieving guidelines recommended beta blocker dose or to HR control has a similar positive impact on survival. When on target dose, supplemental HR control additionally improves survival.
BACKGROUND: Beta blockers improve survival in patients with chronic systolic heart failure (CHF). Whether physicians should aim for target dose, target heart rate (HR), or both is still under debate. METHODS AND RESULTS: We identified 1,669 patients with systolic CHF due to ischemic heart disease or idiopathic dilated cardiomyopathy from the University Hospital Heidelberg and the Clinic of Ludwigshafen, Germany. All patients were treated with an angiotensin converting enzyme inhibitor or angiotensin receptor blocker and had a history of CHF known for at least 6 months. Target dose was defined as treatment with ≥ 95% of the respective published guideline-recommended dose. Target HR was defined as 51-69 bpm. All-cause mortality during the median follow-up of 42.8 months was analysed with respect to beta blocker dosing and resting HR. 201 (12%) patients met the dose target (group A), 285 (17.1%) met the HR target (group B), 627 (37.6%) met no target (group C), and 556 (33.3%) did not receive beta blockers (Group D). 5-year mortality was 23.7, 22.7, 37.6, and 55.6% for group A, B, C, and D, respectively (p < 0.001). Survival for group A patients with a HR ≥ 70 bpm was 28.8% but 14.8% if HR was 50-70 bpm (p = 0.054). CONCLUSIONS: Achieving guidelines recommended beta blocker dose or to HR control has a similar positive impact on survival. When on target dose, supplemental HR control additionally improves survival.
Authors: Ali Vazir; Brian Claggett; Pardeep Jhund; Davide Castagno; Hicham Skali; Salim Yusuf; Karl Swedberg; Christopher B Granger; John J V McMurray; Marc A Pfeffer; Scott D Solomon Journal: Eur Heart J Date: 2014-11-02 Impact factor: 29.983
Authors: Götz Gelbrich; Frank Edelmann; Simone Inkrot; Mitja Lainscak; Svetlana Apostolovic; Aleksandar N Neskovic; Finn Waagstein; Markus Loeffler; Stefan D Anker; Rainer Dietz; Hans-Dirk Düngen Journal: Int J Cardiol Date: 2011-11-30 Impact factor: 4.164
Authors: G Poelzl; J Altenberger; R Pacher; C H Ebner; M Wieser; A Winter; F Fruhwald; C Dornaus; U Ehmsen; S Reiter; R Steinacher; M Huelsmann; V Eder; A Boehmer; L Pilgersdorfer; K Ablasser; D Keroe; H Groebner; J Auer; G Jakl; A Hallas; M Ess; H Ulmer Journal: Int J Cardiol Date: 2014-05-02 Impact factor: 4.164
Authors: Lars Gullestad; John Wikstrand; Prakash Deedwania; Ake Hjalmarson; Kenneth Egstrup; Uri Elkayam; Stephen Gottlieb; Andrew Rashkow; Hans Wedel; Georgina Bermann; John Kjekshus Journal: J Am Coll Cardiol Date: 2005-01-18 Impact factor: 24.094
Authors: Michel Komajda; Pablo Lapuerta; Nancy Hermans; José Ramon Gonzalez-Juanatey; Dirk J van Veldhuisen; Erland Erdmann; Luigi Tavazzi; Philip Poole-Wilson; Claude Le Pen Journal: Eur Heart J Date: 2005-04-12 Impact factor: 29.983
Authors: Gregg C Fonarow; William T Abraham; Nancy M Albert; Wendy Gattis Stough; Mihai Gheorghiade; Barry H Greenberg; Christopher M O'Connor; Jie Lena Sun; Clyde W Yancy; James B Young Journal: Am J Cardiol Date: 2008-09-06 Impact factor: 2.778
Authors: John G F Cleland; Karina V Bunting; Marcus D Flather; Douglas G Altman; Jane Holmes; Andrew J S Coats; Luis Manzano; John J V McMurray; Frank Ruschitzka; Dirk J van Veldhuisen; Thomas G von Lueder; Michael Böhm; Bert Andersson; John Kjekshus; Milton Packer; Alan S Rigby; Giuseppe Rosano; Hans Wedel; Åke Hjalmarson; John Wikstrand; Dipak Kotecha Journal: Eur Heart J Date: 2018-01-01 Impact factor: 29.983
Authors: Ify R Mordi; Bernadet T Santema; Mariëlle Kloosterman; Anna-Maria Choy; Michiel Rienstra; Isabelle van Gelder; Stefan D Anker; John G Cleland; Kenneth Dickstein; Gerasimos Filippatos; Pim van der Harst; Hans L Hillege; Marco Metra; Leong L Ng; Wouter Ouwerkerk; Piotr Ponikowski; Nilesh J Samani; Dirk J van Veldhuisen; Aeilko H Zwinderman; Faiez Zannad; Adriaan A Voors; Chim C Lang Journal: Clin Res Cardiol Date: 2019-01-04 Impact factor: 5.460
Authors: Rasmus Rivinius; Matthias Helmschrott; Ann-Kathrin Rahm; Fabrice F Darche; Dierk Thomas; Tom Bruckner; Andreas O Doesch; Hugo A Katus; Philipp Ehlermann Journal: Clin Res Cardiol Date: 2020-06-22 Impact factor: 5.460