Beta-blocker dosing in community-based treatment of heart failure.
Am Heart J
; 153(6): 1029-36, 2007 Jun.
Article
en En
| MEDLINE
| ID: mdl-17540206
ABSTRACT
BACKGROUND:
Community patients with heart failure (HF) are older, less often treated by HF specialists, and have more comorbidity than those in randomized clinical trials. These differences might affect beta-blocker prescribing in HF.METHODS:
To explore patterns of beta-blocker prescribing for HF in the community and their association with outcomes, we determined carvedilol doses at end titration in 4113 patients from a community-based beta-blocker HF registry according to physician and patient characteristics, HF severity, and rates of hospitalization and death.RESULTS:
Female sex, age > or = 65 years, and left ventricular ejection fraction > or = 35% were associated with lower beta-blocker doses. Average daily dose of beta-blocker was lower with worse baseline New York Heart Association class. More patients of cardiologists achieved carvedilol doses > or = 25 mg twice daily, whereas in those of noncardiologists lower doses were more common. Relative risk of HF hospitalizations or all-cause death was significantly lower with higher doses of beta-blocker.CONCLUSIONS:
Beta-blocker dosing in community HF appears lower than in randomized clinical trials, especially when prescribed by noncardiologists. At all doses, patients taking the beta-blocker carvedilol have a lower incidence of death and HF hospitalization than those discontinuing it, regardless of physician type in the community setting.
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Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Propanolaminas
/
Carbazoles
/
Antagonistas Adrenérgicos beta
/
Insuficiencia Cardíaca
Tipo de estudio:
Clinical_trials
/
Etiology_studies
Límite:
Aged
/
Female
/
Humans
/
Male
/
Middle aged
País/Región como asunto:
America do norte
Idioma:
En
Revista:
Am Heart J
Año:
2007
Tipo del documento:
Article
País de afiliación:
Estados Unidos