Beta-blocker treatment of stable heart failure in primary care.

INTRODUCTION AND OBJECTIVES: Beta-blocker treatment of stable heart failure in primary care. The objective was to evaluate the feasibility and tolerability of uptitrating beta-blockers in patients with stable systolic heart failure seen in primary care. METHODS: Before and after intervention study. The study was conducted in two primary care centers in Barcelona, Spain. Consecutive samples of patients with systolic heart failure who had not received previous beta-blocker treatment were recruited between April 2004 and April 2006. Treatment was started with the lowest dose of bisoprolol or carvedilol and the dose was doubled every two weeks in the absence of contraindications. Patients were followed up for 6 months. RESULTS: The study included 88 patients (76.1% male, 23,9% female, mean age 64.88 years). Of these, 57.1% were treated with bisoprolol and 42.9% with carvedilol. Overall, 75.0% reached the target dose, 21.7% tolerated a dose lower than the target dose, and 3.3% had the beta-blocker withdrawn (due to bradycardia in 1.1%, syncope in 1.1%, and stroke in 1.1%). Adverse events were experienced by 70.4%, the majority of which (57.95%) were resolved without changing treatment. The most common were nausea (42.04%), asthenia (35.22%), and increased dyspnea (17.04%). There were significant improvements in functional class and ejection fraction. CONCLUSIONS: The majority of adverse events were mild. Treatment was withdrawn in only a few patients and most reached the recommended target dose. Appropriately trained primary care physicians can uptitrate beta-blockers in heart failure patients without undue concern.

Betabloqueantes en el tratamiento de la insuficiencia cardiaca estable en atención primaria / Beta-blocker treatment of stable heart failure in primary care

Introducción y objetivos. El objetivo es valorar la factibilidad y la tolerabilidad de la titulación de betabloqueantes en insuficiencia cardiaca sistólica en atención primaria. Métodos. Estudio de intervención antes/después. El estudio se realizó en dos centros de atención primaria de Barcelona. Se incluyó mediante muestreo sucesivo, desde abril de 2004 hasta abril de 2006, a los pacientes con IC sistólica sin tratamiento betabloqueante previo. Se inició titulación con bisoprolol o carvedilol a dosis mínima, doblándose cada 2 semanas en ausencia de contraindicaciones. Seguimiento durante 6 meses. Resultados. Se incluyó a un total de 88 pacientes (76,1% hombres, 23,9% mujeres. Edad media, 64,88 años). Al 57,1% se pautó bisoprolol y al 42,9%, carvedilol. El 75% alcanzaron la dosis diana, el 21,7% toleraron dosis menores de la diana y en el 3,3% hubo de retirarse el betabloqueante (1,1% bradicardia, 1,1% síncope, 1,1% accidente cerebrovascular). El 70,4% de los pacientes presentaron acontecimientos adversos. La mayoría de éstos (57,95%) se resolvieron sin cambios en el tratamiento. Los más frecuentes fueron: mareo (42,04%), astenia (35,22%) y el aumento de la disnea (17,04%). Hubo una mejora significativa de la clase funcional y de la fracción de eyección. Conclusiones. La mayoría de los acontecimientos adversos son leves. Las retiradas del tratamiento son escasas y la mayoría de los pacientes alcanzaron la dosis diana recomendada. Los médicos de atención primaria convenientemente formados pueden titular con seguridad los BB (AU)

Introduction and objectives. Beta-blocker treatment of stable heart failure in primary care. The objective was to evaluate the feasibility and tolerability of uptitrating beta-blockers in patients with stable systolic heart failure seen in primary care. Methods. Before and after intervention study. The study was conducted in two primary care centers in Barcelona, Spain. Consecutive samples of patients with systolic heart failure who had not received previous beta-blocker treatment were recruited between April 2004 and April 2006. Treatment was started with the lowest dose of bisoprolol or carvedilol and the dose was doubled every two weeks in the absence of contraindications. Patients were followed up for 6 months. Results. The study included 88 patients (76.1% male, 23,9% female, mean age 64.88 years). Of these, 57.1% were treated with bisoprolol and 42.9% with carvedilol. Overall, 75.0% reached the target dose, 21.7% tolerated a dose lower than the target dose, and 3.3% had the beta-blocker withdrawn (due to bradycardia in 1.1%, syncope in 1.1%, and stroke in 1.1%). Adverse events were experienced by 70.4%, the majority of which (57.95%) were resolved without changing treatment. The most common were nausea (42.04%), asthenia (35.22%), and increased dyspnea (17.04%). There were significant improvements in functional class and ejection fraction. Conclusions. The majority of adverse events were mild. Treatment was withdrawn in only a few patients and most reached the recommended target dose. Appropriately trained primary care physicians can uptitrate beta-blockers in heart failure patients without undue concern (AU)