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17.05.2018 | Original Paper

Beta blockers and chronic heart failure patients: prognostic impact of a dose targeted beta blocker therapy vs. heart rate targeted strategy

verfasst von: Anna Corletto, Hanna Fröhlich, Tobias Täger, Matthias Hochadel, Ralf Zahn, Caroline Kilkowski, Ralph Winkler, Jochen Senges, Hugo A. Katus, Lutz Frankenstein

Erschienen in: Clinical Research in Cardiology | Ausgabe 11/2018

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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.

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Titel: Beta blockers and chronic heart failure patients: prognostic impact of a dose targeted beta blocker therapy vs. heart rate targeted strategy
verfasst von: Anna Corletto
Hanna Fröhlich
Tobias Täger
Matthias Hochadel
Ralf Zahn
Caroline Kilkowski
Ralph Winkler
Jochen Senges
Hugo A. Katus
Lutz Frankenstein
Publikationsdatum: 17.05.2018
Verlag: Springer Berlin Heidelberg
Erschienen in: Clinical Research in Cardiology / Ausgabe 11/2018
Print ISSN: 1861-0684
Elektronische ISSN: 1861-0692
DOI: https://doi.org/10.1007/s00392-018-1277-4

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Springer Medizin

Beta blockers and chronic heart failure patients: prognostic impact of a dose targeted beta blocker therapy vs. heart rate targeted strategy

Abstract

Background

Methods and Results

Conclusions

Neu im Fachgebiet Kardiologie

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Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

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Springer Medizin

Abstract

Background

Methods and Results

Conclusions

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