Dosing of Beta-Blocker Therapy Before, During, and After Hospitalization for Heart Failure (from Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure)

被引:58
作者
Fonarow, Gregg C. [1 ]
Abraham, William T. [2 ]
Albert, Nancy M. [3 ]
Stough, Wendy Gattis [5 ,6 ]
Gheorghiade, Mihai [7 ]
Greenberg, Barry H. [8 ]
O'Connor, Christopher M. [9 ]
Sun, Jie Lena
Yancy, Clyde W. [10 ]
Young, James B. [4 ]
机构
[1] Univ Calif Los Angeles, Med Ctr, Dept Med, Los Angeles, CA 90024 USA
[2] Ohio State Univ, Div Cardiol, Columbus, OH 43210 USA
[3] Cleveland Clin Fdn, George M & Linda H Kaufman Ctr Heart Failure, Cleveland, OH 44195 USA
[4] Cleveland Clin Fdn, Dept Cardiovasc Med, Heart Failure Sect Cleveland, Cleveland, OH 44195 USA
[5] Duke Univ, Med Ctr, Dept Med, Durham, NC 27710 USA
[6] Campbell Univ, Sch Pharm, Dept Clin Res, Res Triangle Pk, NC USA
[7] Northwestern Univ, Feinberg Sch Med, Div Cardiol, Chicago, IL 60611 USA
[8] USCD Med Ctr, Dept Med, San Diego, CA USA
[9] Duke Univ, Med Ctr, Duke Clin Res Inst, Div Cardiol, Durham, NH USA
[10] Baylor Univ, Med Ctr, Dallas, TX USA
关键词
D O I
10.1016/j.amjcard.2008.07.045
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Heart failure (HF) guidelines recommend that beta blockers be titrated to achieve the target doses shown to be effective in major clinical trials, if tolerated. Little is known, however, regarding the doses of beta blockers used in patients with HF in routine clinical practice before, during, and after hospitalization for HF. The Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure (OPTIMIZE-HF) enrolled 5,791 patients admitted with HF in a registry with prespecified 60- to 90-day follow-up at 91 academic and community hospitals throughout the United States. Among 2,373 patients with systolic HF eligible for beta blockers at discharge, 1,350 (56.9%) were receiving beta-blocker therapy before admission and continued on therapy, and 632 (26.6%) were newly started. The mean total daily dose for beta blockers before hospital admission was <1/2 the recommended target dose (carvedilol 21.5 +/- 17.8 mg and metoprolol succinate 69.2 +/- 51.9 mg), with infrequent up- or down-titration during the HF hospitalization. More than 2/3 of patients had no change in their beta-blocker doses in the first 60 to 90 days after hospital discharge. At 60- to 90-day postdischarge follow-up, only 17.5% and 7.9% of patients were being treated with recommended target doses of carvedilol and metoprolol succinate, respectively. In conclusion, these data reveal that the doses of beta blockers applied in clinical practice are substantially less that the doses achieved in randomized clinical trials in HF and recommended in national guidelines. In the first 60 to 90 days after hospital discharge, little up-titration in beta-blocker dosing occurs. Further efforts are needed to help understand and overcome this beta-blocker titration gap. (C) 2008 Elsevier Inc. All rights reserved. (Am J Cardiol 2008;102:1524-1529)
引用
收藏
页码:1524 / 1529
页数:6
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