Prognostic role of β-blocker selectivity and dosage regimens in heart failure patients. Insights from the MECKI score database

Stefania Paolillo, Massimo Mapelli, Alice Bonomi, Ugo Corrà, Massimo F. Piepoli, Fabrizio Veglia, Elisabetta Salvioni, Piero Gentile, Rocco Lagioia, Marco Metra, Giuseppe Limongelli, Gianfranco Sinagra, Gaia Cattadori, Angela Beatrice Scardovi, Valentina Carubelli, Domenico Scrutino, Roberto Badagliacca, Rosa Raimondo, Michele Emdin, Damiano MagrìMichele Correale, Gianfranco Parati, Sergio Caravita, Emanuele Spadafora, Federica Re, Mariantonietta Cicoira, Maria Frigerio, Maurizio Bussotti, Chiara Minà, Fabrizio Oliva, Elisa Battaia, Romualdo Belardinelli, Alessandro Mezzani, Luigi E. Pastormerlo, Andrea Di Lenarda, Claudio Passino, Susanna Sciomer, Annamaria Iorio, Elena Zambon, Marco Guazzi, Giuseppe Pacileo, Roberto Ricci, Mauro Contini, Anna Apostolo, Pietro Palermo, Francesco Clemenza, Giovanni Marchese, Simone Maurizio Binno, Carlo Lombardi, Andrea Passantino, Pasquale Perrone-Filardi, Piergiuseppe Agostoni

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

Aims: The use of β-blockers represents a milestone in the treatment of heart failure with reduced ejection fraction (HFrEF). Few studies have compared β-blockers in HFrEF, and there is little data on the effects of different doses. The present study aimed to investigate in a large database of HFrEF patients (MECKI score database) the association of β-blocker treatment with a composite outcome of cardiovascular death, urgent heart transplantation or left ventricular assist device implantation, addressing the role of β-selectivity and dosage regimens. Methods and results: In 5242 HFrEF patients, we investigated the role of: (i) β-blocker treatment vs. non-β-blocker treatment, (ii) β1-/β2-receptor-blockers vs. β1-selective blockers, and (iii) daily β-blocker dose. Patients were followed for 3.58years, and 1101 events (18.3%) were observed; 4435 patients (86.8%) were on β-blockers, while 807 (13.2%) were not. At 5years, β-blocker-patients showed a better outcome than non-β-blocker-subjects [hazard ratio (HR) 0.48, P<0.0001], while also considering potential confounders. A comparable prognosis was observed at 5years in the β1-/β2-receptor-blocker (n=2219) vs. β1-selective group (n=2216) (HR 0.95, P=ns). A better prognosis was observed in high-dose (>25mg carvedilol equivalent daily dose, n=1005) patients than in both medium dose (12.5-25mg, n=1431) and low dose (<12.5mg, n=1960) (HR 1.97, P<0.001; HR 1.95, P=0.001, respectively), with no differences between the last two groups (HR 0.84, P=ns). Conclusion: In a large population of chronic HFrEF patients, β-blockers were associated with a more favourable prognosis without any difference between β1- and β2-receptor-blockers vs. β1-selective blockers. A better outcome was observed in subjects receiving a high daily dose.

Original languageEnglish
Pages (from-to)904-914
Number of pages10
JournalEuropean Journal of Heart Failure
DOIs
Publication statusPublished - Jul 2017

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Heart Failure
Databases
Heart-Assist Devices
Heart Transplantation
Treatment Failure
Therapeutics
Population

Keywords

  • Equivalent dose
  • Heart failure
  • Prognosis
  • β-Blocker selectivity
  • β-Blockers

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Prognostic role of β-blocker selectivity and dosage regimens in heart failure patients. Insights from the MECKI score database. / Paolillo, Stefania; Mapelli, Massimo; Bonomi, Alice; Corrà, Ugo; Piepoli, Massimo F.; Veglia, Fabrizio; Salvioni, Elisabetta; Gentile, Piero; Lagioia, Rocco; Metra, Marco; Limongelli, Giuseppe; Sinagra, Gianfranco; Cattadori, Gaia; Scardovi, Angela Beatrice; Carubelli, Valentina; Scrutino, Domenico; Badagliacca, Roberto; Raimondo, Rosa; Emdin, Michele; Magrì, Damiano; Correale, Michele; Parati, Gianfranco; Caravita, Sergio; Spadafora, Emanuele; Re, Federica; Cicoira, Mariantonietta; Frigerio, Maria; Bussotti, Maurizio; Minà, Chiara; Oliva, Fabrizio; Battaia, Elisa; Belardinelli, Romualdo; Mezzani, Alessandro; Pastormerlo, Luigi E.; Lenarda, Andrea Di; Passino, Claudio; Sciomer, Susanna; Iorio, Annamaria; Zambon, Elena; Guazzi, Marco; Pacileo, Giuseppe; Ricci, Roberto; Contini, Mauro; Apostolo, Anna; Palermo, Pietro; Clemenza, Francesco; Marchese, Giovanni; Binno, Simone Maurizio; Lombardi, Carlo; Passantino, Andrea; Perrone-Filardi, Pasquale; Agostoni, Piergiuseppe.

In: European Journal of Heart Failure, 07.2017, p. 904-914.

Research output: Contribution to journalArticle

Paolillo, S, Mapelli, M, Bonomi, A, Corrà, U, Piepoli, MF, Veglia, F, Salvioni, E, Gentile, P, Lagioia, R, Metra, M, Limongelli, G, Sinagra, G, Cattadori, G, Scardovi, AB, Carubelli, V, Scrutino, D, Badagliacca, R, Raimondo, R, Emdin, M, Magrì, D, Correale, M, Parati, G, Caravita, S, Spadafora, E, Re, F, Cicoira, M, Frigerio, M, Bussotti, M, Minà, C, Oliva, F, Battaia, E, Belardinelli, R, Mezzani, A, Pastormerlo, LE, Lenarda, AD, Passino, C, Sciomer, S, Iorio, A, Zambon, E, Guazzi, M, Pacileo, G, Ricci, R, Contini, M, Apostolo, A, Palermo, P, Clemenza, F, Marchese, G, Binno, SM, Lombardi, C, Passantino, A, Perrone-Filardi, P & Agostoni, P 2017, 'Prognostic role of β-blocker selectivity and dosage regimens in heart failure patients. Insights from the MECKI score database', European Journal of Heart Failure, pp. 904-914. https://doi.org/10.1002/ejhf.775
Paolillo, Stefania ; Mapelli, Massimo ; Bonomi, Alice ; Corrà, Ugo ; Piepoli, Massimo F. ; Veglia, Fabrizio ; Salvioni, Elisabetta ; Gentile, Piero ; Lagioia, Rocco ; Metra, Marco ; Limongelli, Giuseppe ; Sinagra, Gianfranco ; Cattadori, Gaia ; Scardovi, Angela Beatrice ; Carubelli, Valentina ; Scrutino, Domenico ; Badagliacca, Roberto ; Raimondo, Rosa ; Emdin, Michele ; Magrì, Damiano ; Correale, Michele ; Parati, Gianfranco ; Caravita, Sergio ; Spadafora, Emanuele ; Re, Federica ; Cicoira, Mariantonietta ; Frigerio, Maria ; Bussotti, Maurizio ; Minà, Chiara ; Oliva, Fabrizio ; Battaia, Elisa ; Belardinelli, Romualdo ; Mezzani, Alessandro ; Pastormerlo, Luigi E. ; Lenarda, Andrea Di ; Passino, Claudio ; Sciomer, Susanna ; Iorio, Annamaria ; Zambon, Elena ; Guazzi, Marco ; Pacileo, Giuseppe ; Ricci, Roberto ; Contini, Mauro ; Apostolo, Anna ; Palermo, Pietro ; Clemenza, Francesco ; Marchese, Giovanni ; Binno, Simone Maurizio ; Lombardi, Carlo ; Passantino, Andrea ; Perrone-Filardi, Pasquale ; Agostoni, Piergiuseppe. / Prognostic role of β-blocker selectivity and dosage regimens in heart failure patients. Insights from the MECKI score database. In: European Journal of Heart Failure. 2017 ; pp. 904-914.
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T1 - Prognostic role of β-blocker selectivity and dosage regimens in heart failure patients. Insights from the MECKI score database

AU - Paolillo, Stefania

AU - Mapelli, Massimo

AU - Bonomi, Alice

AU - Corrà, Ugo

AU - Piepoli, Massimo F.

AU - Veglia, Fabrizio

AU - Salvioni, Elisabetta

AU - Gentile, Piero

AU - Lagioia, Rocco

AU - Metra, Marco

AU - Limongelli, Giuseppe

AU - Sinagra, Gianfranco

AU - Cattadori, Gaia

AU - Scardovi, Angela Beatrice

AU - Carubelli, Valentina

AU - Scrutino, Domenico

AU - Badagliacca, Roberto

AU - Raimondo, Rosa

AU - Emdin, Michele

AU - Magrì, Damiano

AU - Correale, Michele

AU - Parati, Gianfranco

AU - Caravita, Sergio

AU - Spadafora, Emanuele

AU - Re, Federica

AU - Cicoira, Mariantonietta

AU - Frigerio, Maria

AU - Bussotti, Maurizio

AU - Minà, Chiara

AU - Oliva, Fabrizio

AU - Battaia, Elisa

AU - Belardinelli, Romualdo

AU - Mezzani, Alessandro

AU - Pastormerlo, Luigi E.

AU - Lenarda, Andrea Di

AU - Passino, Claudio

AU - Sciomer, Susanna

AU - Iorio, Annamaria

AU - Zambon, Elena

AU - Guazzi, Marco

AU - Pacileo, Giuseppe

AU - Ricci, Roberto

AU - Contini, Mauro

AU - Apostolo, Anna

AU - Palermo, Pietro

AU - Clemenza, Francesco

AU - Marchese, Giovanni

AU - Binno, Simone Maurizio

AU - Lombardi, Carlo

AU - Passantino, Andrea

AU - Perrone-Filardi, Pasquale

AU - Agostoni, Piergiuseppe

PY - 2017/7

Y1 - 2017/7

N2 - Aims: The use of β-blockers represents a milestone in the treatment of heart failure with reduced ejection fraction (HFrEF). Few studies have compared β-blockers in HFrEF, and there is little data on the effects of different doses. The present study aimed to investigate in a large database of HFrEF patients (MECKI score database) the association of β-blocker treatment with a composite outcome of cardiovascular death, urgent heart transplantation or left ventricular assist device implantation, addressing the role of β-selectivity and dosage regimens. Methods and results: In 5242 HFrEF patients, we investigated the role of: (i) β-blocker treatment vs. non-β-blocker treatment, (ii) β1-/β2-receptor-blockers vs. β1-selective blockers, and (iii) daily β-blocker dose. Patients were followed for 3.58years, and 1101 events (18.3%) were observed; 4435 patients (86.8%) were on β-blockers, while 807 (13.2%) were not. At 5years, β-blocker-patients showed a better outcome than non-β-blocker-subjects [hazard ratio (HR) 0.48, P<0.0001], while also considering potential confounders. A comparable prognosis was observed at 5years in the β1-/β2-receptor-blocker (n=2219) vs. β1-selective group (n=2216) (HR 0.95, P=ns). A better prognosis was observed in high-dose (>25mg carvedilol equivalent daily dose, n=1005) patients than in both medium dose (12.5-25mg, n=1431) and low dose (<12.5mg, n=1960) (HR 1.97, P<0.001; HR 1.95, P=0.001, respectively), with no differences between the last two groups (HR 0.84, P=ns). Conclusion: In a large population of chronic HFrEF patients, β-blockers were associated with a more favourable prognosis without any difference between β1- and β2-receptor-blockers vs. β1-selective blockers. A better outcome was observed in subjects receiving a high daily dose.

AB - Aims: The use of β-blockers represents a milestone in the treatment of heart failure with reduced ejection fraction (HFrEF). Few studies have compared β-blockers in HFrEF, and there is little data on the effects of different doses. The present study aimed to investigate in a large database of HFrEF patients (MECKI score database) the association of β-blocker treatment with a composite outcome of cardiovascular death, urgent heart transplantation or left ventricular assist device implantation, addressing the role of β-selectivity and dosage regimens. Methods and results: In 5242 HFrEF patients, we investigated the role of: (i) β-blocker treatment vs. non-β-blocker treatment, (ii) β1-/β2-receptor-blockers vs. β1-selective blockers, and (iii) daily β-blocker dose. Patients were followed for 3.58years, and 1101 events (18.3%) were observed; 4435 patients (86.8%) were on β-blockers, while 807 (13.2%) were not. At 5years, β-blocker-patients showed a better outcome than non-β-blocker-subjects [hazard ratio (HR) 0.48, P<0.0001], while also considering potential confounders. A comparable prognosis was observed at 5years in the β1-/β2-receptor-blocker (n=2219) vs. β1-selective group (n=2216) (HR 0.95, P=ns). A better prognosis was observed in high-dose (>25mg carvedilol equivalent daily dose, n=1005) patients than in both medium dose (12.5-25mg, n=1431) and low dose (<12.5mg, n=1960) (HR 1.97, P<0.001; HR 1.95, P=0.001, respectively), with no differences between the last two groups (HR 0.84, P=ns). Conclusion: In a large population of chronic HFrEF patients, β-blockers were associated with a more favourable prognosis without any difference between β1- and β2-receptor-blockers vs. β1-selective blockers. A better outcome was observed in subjects receiving a high daily dose.

KW - Equivalent dose

KW - Heart failure

KW - Prognosis

KW - β-Blocker selectivity

KW - β-Blockers

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