TY - JOUR
T1 - Treatment of chronic heart failure with β adrenergic blockade beyond controlled clinical trials
T2 - The BRING-UP experience
AU - Maggioni, Aldo P.
AU - Sinagra, G.
AU - Opasich, C.
AU - Geraci, E.
AU - Gorini, M.
AU - Gronda, E.
AU - Lucci, D.
AU - Tognoni, G.
AU - Balli, E.
AU - Tavazzi, L.
PY - 2003/3/1
Y1 - 2003/3/1
N2 - Background: Several large controlled trials have shown that β blockers given to patients with heart failure (New York Heart Association functional class II-IV) reduce morbidity and mortality. Despite these impressive results, implementing the use of β blockade in clinical practice appears slow and difficult. The BRING-UP study was designed to tackle this problem. Objectives: To accelerate the adoption of β blockade in clinical practice; to provide an epidemiological estimate of the proportion of patients with heart failure suitable for this treatment in general cardiology care; and to assess effectiveness of these drugs outside the setting of clinical trials. Methods: The design of the study and recommendations derived from available evidence on the use of β blockers were discussed with cardiologists during regional meetings. All consecutive heart failure patients in a one month period, whether treated or not with β blockers, were eligible for the study. In each patient, the decision to prescribe a β blocker was a free choice for the participating physicians. All centres were provided with carvedilol, metoprolol, and bisoprolol at appropriate doses; the choice of the drug and dosage was left to the responsible clinician. All patients were followed for one year. Results: 197 cardiological centres enrolled 3091 patients, 24.9% of whom were already on β blocker treatment at baseline. β Blockers were newly prescribed in 32.7% of cases, more often in younger and less severely ill patients. The mean daily dose of the drugs used at one year corresponded to about 70% of the maximum dose used in clinical trials. Starting treatment with β blockers did not affect the prescription or dosage of other recommended drugs. The overall rate of β blocker treatment increased over the year of the study from 24.9% to 49.7%. During the 12 month period, 351 deaths occurred (11.8%). In multivariate analysis, the use of β blockers was independently associated with a better prognosis, with a relative risk of 0.60 and a lower incidence of hospital admissions for worsening heart failure. Conclusions: The implementation of β blockers in clinical practice is feasible and could be accelerated. These drugs are associated with a lower mortality and reduced hospital admission rates, not only in clinical trials but also in the normal clinical setting.
AB - Background: Several large controlled trials have shown that β blockers given to patients with heart failure (New York Heart Association functional class II-IV) reduce morbidity and mortality. Despite these impressive results, implementing the use of β blockade in clinical practice appears slow and difficult. The BRING-UP study was designed to tackle this problem. Objectives: To accelerate the adoption of β blockade in clinical practice; to provide an epidemiological estimate of the proportion of patients with heart failure suitable for this treatment in general cardiology care; and to assess effectiveness of these drugs outside the setting of clinical trials. Methods: The design of the study and recommendations derived from available evidence on the use of β blockers were discussed with cardiologists during regional meetings. All consecutive heart failure patients in a one month period, whether treated or not with β blockers, were eligible for the study. In each patient, the decision to prescribe a β blocker was a free choice for the participating physicians. All centres were provided with carvedilol, metoprolol, and bisoprolol at appropriate doses; the choice of the drug and dosage was left to the responsible clinician. All patients were followed for one year. Results: 197 cardiological centres enrolled 3091 patients, 24.9% of whom were already on β blocker treatment at baseline. β Blockers were newly prescribed in 32.7% of cases, more often in younger and less severely ill patients. The mean daily dose of the drugs used at one year corresponded to about 70% of the maximum dose used in clinical trials. Starting treatment with β blockers did not affect the prescription or dosage of other recommended drugs. The overall rate of β blocker treatment increased over the year of the study from 24.9% to 49.7%. During the 12 month period, 351 deaths occurred (11.8%). In multivariate analysis, the use of β blockers was independently associated with a better prognosis, with a relative risk of 0.60 and a lower incidence of hospital admissions for worsening heart failure. Conclusions: The implementation of β blockers in clinical practice is feasible and could be accelerated. These drugs are associated with a lower mortality and reduced hospital admission rates, not only in clinical trials but also in the normal clinical setting.
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M3 - Article
C2 - 12591836
AN - SCOPUS:0037369269
VL - 89
SP - 299
EP - 305
JO - Heart
JF - Heart
SN - 1355-6037
IS - 3
ER -