Jeffrey Triska1, Juan Tamargo2, Biykem Bozkurt3, Uri Elkayam4, Addison Taylor5, Yochai Birnbaum3. 1. Department of Medicine, Baylor College of Medicine, Houston, TX, USA. u233989@bcm.edu. 2. Department of Pharmacology and Toxicology School of Medicine, Institute Gregorio Marañón, Universidad Complutense, Madrid, Spain. 3. Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, TX, USA. 4. Department of Medicine, Division of Cardiovascular Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA. 5. Department of Medicine, Division of Hypertension and Clinical Pharmacology, Baylor College of Medicine, Houston, TX, USA.
Abstract
PURPOSE: The 2021 European Society of Cardiology guidelines on acute and chronic heart failure (HF) recommend that non-dihydropyridine calcium channel blockers (NDCC) should be avoided in patients with HF with reduced ejection fraction. It also emphasizes that beta-blockers only be initiated in clinically stable, euvolemic patients. Despite these recommendations, NDCC and beta-blockers are often still employed in patients with AF with rapid ventricular response and acute decompensated HF. The relative safety and efficacy of these therapies in this setting is unclear. METHODS: To address the question of the safety and efficacy of NDCC and beta-blockers for acute rate control in decompensated HF, we provide a perspective on the literature of NDCC and beta-blockers in chronic HF with reduced and preserved ejection fraction and AF, including trials on the management of AF with rapid ventricular response with and without HF. RESULTS: Robust data demonstrates mortality benefits when beta-blockers are used in patients with chronic HF with reduced ejection fraction. The data that inform the contraindication of NDCC in HF with reduced ejection fraction are outdated and were not primarily designed to address the efficacy and safety of rate control of AF in patients with HF. Several studies indicate that for acute rate control, NDCC and beta-blockers are both efficacious therapies, especially in the setting of tachycardia-induced cardiomyopathy. CONCLUSION: Future studies are needed to assess the safety and efficacy of beta-blockers and NDCC in both acute and chronic AF with HF with reduced and preserved ejection fraction.
PURPOSE: The 2021 European Society of Cardiology guidelines on acute and chronic heart failure (HF) recommend that non-dihydropyridine calcium channel blockers (NDCC) should be avoided in patients with HF with reduced ejection fraction. It also emphasizes that beta-blockers only be initiated in clinically stable, euvolemic patients. Despite these recommendations, NDCC and beta-blockers are often still employed in patients with AF with rapid ventricular response and acute decompensated HF. The relative safety and efficacy of these therapies in this setting is unclear. METHODS: To address the question of the safety and efficacy of NDCC and beta-blockers for acute rate control in decompensated HF, we provide a perspective on the literature of NDCC and beta-blockers in chronic HF with reduced and preserved ejection fraction and AF, including trials on the management of AF with rapid ventricular response with and without HF. RESULTS: Robust data demonstrates mortality benefits when beta-blockers are used in patients with chronic HF with reduced ejection fraction. The data that inform the contraindication of NDCC in HF with reduced ejection fraction are outdated and were not primarily designed to address the efficacy and safety of rate control of AF in patients with HF. Several studies indicate that for acute rate control, NDCC and beta-blockers are both efficacious therapies, especially in the setting of tachycardia-induced cardiomyopathy. CONCLUSION: Future studies are needed to assess the safety and efficacy of beta-blockers and NDCC in both acute and chronic AF with HF with reduced and preserved ejection fraction.
Authors: Mihai Gheorghiade; Faiez Zannad; George Sopko; Liviu Klein; Ileana L Piña; Marvin A Konstam; Barry M Massie; Edmond Roland; Shari Targum; Sean P Collins; Gerasimos Filippatos; Luigi Tavazzi Journal: Circulation Date: 2005-12-20 Impact factor: 29.690
Authors: Gerhard Hindricks; Tatjana Potpara; Nikolaos Dagres; Elena Arbelo; Jeroen J Bax; Carina Blomström-Lundqvist; Giuseppe Boriani; Manuel Castella; Gheorghe-Andrei Dan; Polychronis E Dilaveris; Laurent Fauchier; Gerasimos Filippatos; Jonathan M Kalman; Mark La Meir; Deirdre A Lane; Jean-Pierre Lebeau; Maddalena Lettino; Gregory Y H Lip; Fausto J Pinto; G Neil Thomas; Marco Valgimigli; Isabelle C Van Gelder; Bart P Van Putte; Caroline L Watkins Journal: Eur Heart J Date: 2021-02-01 Impact factor: 29.983