In the Journals

Higher beta-blocker dose, lower heart rate confer improved outcomes in HFrEF

Patients with HF with reduced ejection fraction who were treated with a higher-dose beta-blocker and achieved a lower heart rate had reduced risk for mortality, according to a study published in The American Journal of Cardiology.

Tarek Ajam, MD, MS, fellow of cardiovascular medicine at Aurora Health Care in Milwaukee, and colleagues analyzed data from Veterans Affairs databases of patients diagnosed with HFrEF between 2007 and January 2015. Patients who took a low-dose beta-blocker, defined as less than 25 mg carvedilol per day, were matched with patients who took a high-dose beta-blocker, defined as greater than 25 mg carvedilol per day. In both groups, there were 36,168 patients with a mean age of 71 years; 2% were women.

Patients were followed up from the first beta-blocker prescription fill date at a Veterans Affairs pharmacy to death or until the end of the study for a mean of 1,192 days.

During follow-up, patients who achieved a lower heart rate while taking high-dose beta-blockers had an improved survival rate compared with those taking low-dose beta-blockers.

The high-dose beta-blocker group had lower overall mortality vs. the low-dose beta-blocker group (HR = 0.74; 95% CI, 0.73-0.76), which remained consistent after adjusting for comorbidities and patient characteristics (HR = 0.75; 95% CI, 0.73-0.77).

“Higher [beta]-blocker dose was additive to [heart rate] lowering in reducing long-term mortality in HFrEF and was independently associated with better survival irrespective of [heart rate] lowering,” Ajam and colleagues wrote. – by Darlene Dobkowski

Disclosures: Ajam reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

Patients with HF with reduced ejection fraction who were treated with a higher-dose beta-blocker and achieved a lower heart rate had reduced risk for mortality, according to a study published in The American Journal of Cardiology.

Tarek Ajam, MD, MS, fellow of cardiovascular medicine at Aurora Health Care in Milwaukee, and colleagues analyzed data from Veterans Affairs databases of patients diagnosed with HFrEF between 2007 and January 2015. Patients who took a low-dose beta-blocker, defined as less than 25 mg carvedilol per day, were matched with patients who took a high-dose beta-blocker, defined as greater than 25 mg carvedilol per day. In both groups, there were 36,168 patients with a mean age of 71 years; 2% were women.

Patients were followed up from the first beta-blocker prescription fill date at a Veterans Affairs pharmacy to death or until the end of the study for a mean of 1,192 days.

During follow-up, patients who achieved a lower heart rate while taking high-dose beta-blockers had an improved survival rate compared with those taking low-dose beta-blockers.

The high-dose beta-blocker group had lower overall mortality vs. the low-dose beta-blocker group (HR = 0.74; 95% CI, 0.73-0.76), which remained consistent after adjusting for comorbidities and patient characteristics (HR = 0.75; 95% CI, 0.73-0.77).

“Higher [beta]-blocker dose was additive to [heart rate] lowering in reducing long-term mortality in HFrEF and was independently associated with better survival irrespective of [heart rate] lowering,” Ajam and colleagues wrote. – by Darlene Dobkowski

Disclosures: Ajam reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.