Effect of a community heart failure clinic on uptake of β blockers by patients with obstructive airways disease and heart failure. Issue 3 (10th June 2005)

• Record Type: Journal Article
• Authors: Shelton, R J; Rigby, A S; Cleland, J G F; Clark, A L
• Is Part Of: Heart. Volume 92:Issue 3(2006)
• Page Start: 331
• Page End: 336
• Publication Date: 2005-06-10
• Subjects: ACE, angiotensin converting enzyme -- CI, confidence interval -- COMET, carvedilol or metoprolol European trial -- COPD, chronic obstructive pulmonary disease -- COPERNICUS, carvedilol prospective randomised cumulative survival -- FEV1, forced expiratory volume in one second -- FVC, forced vital capacity -- IMPACT-HF, initiation management predischarge process for assessment of carvedilol therapy for heart failure -- MERIT-HF, metoprolol CR/XL randomised intervention trial in congestive heart failure -- NYHA, New York Heart Association -- OR, odds ratio; heart failure -- β blockers -- chronic obstructive pulmonary disease; Heart -- Diseases -- Treatment -- Periodicals; Cardiology -- Periodicals; 616.12
• DOI: 10.1136/hrt.2004.059758
• Languages: English
• ISSNs: 1355-6037

Abstract

Abstract : Objective: To determine the pattern of β blocker prescribing over one year in a heart failure clinic with a structured approach towards initiation and dose titration and to give a real life perspective on β blocker use, compliance, and target dose achievement. Methods: Data were retrospectively analysed on 513 consecutive patients regularly attending a community heart failure clinic over a year. Systolic dysfunction was determined from two dimensional echocardiography (left ventricular ejection fraction ⩽ 40%) and lung function was assessed by spirometry. All patients were considered for β blocker initiation and dose up titration. Results: Within one year 157 patients died. 143 patients started β blockers resulting in 315 (88%) patients taking β blockers at one year; 38% were taking the target dose. 124 had evidence of airways obstruction at baseline, 100 (81%) of whom were taking β blockers at one year. Forced expiratory volume in one second (1.1 v 1.5 l, p < 0.01) and forced vital capacity (2.3 v 2.5 l/min, p = 0.2) were not reduced in patients with airways obstruction who received β blockers. Daily doses of β blockers at one year did not differ statistically between patients with obstructive and patients with non-obstructive spirometry results. 12 patients discontinued β blockers and 14 required dose reduction due to side effects. Conclusion: The majority of patients with heart failure and obstructive airways disease can safely tolerate low dose initiation and gradual up titration of β blockers.