TY  - BOOK
AU  - Dooley, Daniel J
AU  - Gupta, Neha
TI  - Role of High-Dose Beta-Blockers in Patients with Heart Failure with Preserved Ejection Fraction and Elevated Heart Rate: High-dose beta-blocker and outcomes in HFpEF
SN  - 0002-9343
PY  - 2018///
KW  - IN PROCESS -- NOT YET INDEXED
KW  - MedStar Heart & Vascular Institute
KW  - Journal Article
N1  - Available online from MWHC library: 1995 - present, Available in print through MWHC library: 1999 - present
N2  - BACKGROUND: Beta-blockers in high target doses are recommended for heart failure with reduced ejection fraction (HFrEF) but not for preserved ejection fraction (HFpEF). Treatment benefits are often more pronounced in high-risk subgroups, and HFpEF patients with heart rate >=70 beats/minute have emerged as such a high-risk subgroup. We examined associations of high-dose beta-blocker use with outcomes in these patients; CONCLUSIONS: In patients with HFpEF and heart rate >=70 beats/minute, high-dose beta-blocker use was associated with a significantly lower risk of death. Future randomized controlled trials are needed to examine this association; Copyright (c) 2018. Published by Elsevier Inc; METHODS: Of the 8462 hospitalized patients with HFpEF (ejection fraction >=50%) in Medicare-linked OPTIMIZE-HF registry, 5422 had discharge heart rate >=70 beats/minute. Of these, 4537 had no contraindications to beta-blocker use, of which 2797 (2592 with dose data) received prescriptions for beta-blockers. Of the 2592, 730 received high-dose beta-blockers, defined as atenolol >=100 mg/day, carvedilol >=50 mg/day, metoprolol tartrate or succinate >=200 mg/day, or bisoprolol >=10 mg/day, and 1740 received no beta-blockers. Using propensity scores for the receipt of high-dose beta-blockers, we assembled a matched cohort of 1280 patients, balanced on 58 characteristics; RESULTS: All-cause mortality occurred in 63% and 68% of matched patients receiving high-dose beta-blocker versus no beta-blocker during 6 years (median, 2.8) of follow-up, respectively (hazard ratio {HR}, 0.86; 95% confidence interval {CI}, 0.75-0.98; p=0.027). HRs (95% CIs) for all-cause readmission and the combined endpoint of all-cause readmission or all-cause mortality associated with high-dose beta-blocker use were 0.90 (0.81-1.02) and 0.89 (0.80-1.00), respectively
UR  - https://dx.doi.org/10.1016/j.amjmed.2018.07.008
ER  -