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

S. Paolillo, M. Mapelli, A. Bonomi, U. Corrà, M. Piepoli, F. Veglia, E. Salvioni, P. Gentile, R. Lagioia, M. Metra, G. Limongelli, G. Sinagra, G. Cattadori, A.B. Scardovi, V. Carubelli, D. Scrutino, R. Badagliacca, R. Raimondo, M. Emdin, D. MagrìM. Correale, G. Parati, S. Caravita, E. Spadafora, F. Re, M. Cicoira, M. Frigerio, M. Bussotti, C. Minà, F. Oliva, E. Battaia, R. Belardinelli, A. Mezzani, L. Pastormerlo, A. Di Lenarda, C. Passino, S. Sciomer, A. Iorio, E. Zambon, M. Guazzi, G. Pacileo, R. Ricci, M. Contini, A. Apostolo, P. Palermo, F. Clemenza, G. Marchese, C. Lombardi, A. Passantino, P. Agostoni

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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 3.58 years, and 1101 events (18.3%) were observed; 4435 patients (86.8%) were on β-blockers, while 807 (13.2%) were not. At 5 years, 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 5 years 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 (>2 5 mg carvedilol equivalent daily dose, n = 1005) patients than in both medium dose (12.5–25 mg, n = 1431) and low dose (
Original languageEnglish
Pages (from-to)904-914
Number of pages11
JournalEuropean Journal of Heart Failure
Volume19
Issue number7
DOIs
Publication statusPublished - 2017

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Keywords

  • Equivalent dose
  • Heart failure
  • Prognosis
  • β-Blocker selectivity
  • β-Blockers
  • beta adrenergic receptor blocking agent
  • bisoprolol
  • carvedilol
  • metoprolol
  • nebivolol
  • adult
  • Article
  • cohort analysis
  • controlled study
  • drug dose regimen
  • drug megadose
  • drug selectivity
  • female
  • heart failure with reduced ejection fraction
  • human
  • low drug dose
  • major clinical study
  • male
  • Metabolic Exercise Cardiac Kidney Index score
  • priority journal
  • prognosis
  • retrospective study
  • scoring system
  • treatment outcome

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