Characteristics Associated with Upper-Range Doses of Beta-Blockers and Angiotensin-Renin Inhibitors in Reduced Ejection Fraction.
Isr Med Assoc J
; 22(7): 441-445, 2020 Jul.
Article
en En
| MEDLINE
| ID: mdl-33236570
ABSTRACT
BACKGROUND:
Heart failure (HF) patients with reduced ejection fraction (HFrEF) are frequently treated with sub-optimal doses of angiotensin converting enzyme-inhibitors (ACE-Is), angiotensin receptor blockers (ARBs), and beta blockers (BBs).OBJECTIVES:
To determine factors associated with attaining upper-range doses in patients with HFrEF.METHODS:
We examined treatment in patients with left ventricular ejection fraction (LVEF) ≤ 40% in a community-based, dedicated heart-failure clinic. Upper-range doses were defined as ≥ 75% of target recommended doses by heart failure society guidelines.RESULTS:
The majority of the 215 patients were men (82%); median age at presentation 73 years (interquartile range [IQR] 65-78) and LVEF of 30% (IQR 25-35%). Following the up-titration program, 41% and 35% of patients achieved upper-range doses of ACE-Is/ARBs and BBs, respectively. Higher body mass index (BMI) was the only parameter found to be associated with achieving upper-range doses of ACE-I/ARBs (odds ratio [OR] 1.13, 95% confidence interval [95%CI] 1.05-1.22, P = 0.001). More patients achieved this target as BMI increased, with a sharp decline in the highest obesity category (BMI ≥ 40 m2/kg). Attaining upper-range doses of BBs was associated with pre-existing diabetes mellitus (DM) (OR 2.6, 95%CI 1.34-5.19, P = 0.005); women were associated with attaining lower BBs doses (OR 0.34, 95%CI 0.13-0.90, P = 0.031).CONCLUSIONS:
Achieving upper-range doses of ACE-Is/ARBs and BBs in HFrEF outpatients in a treatment up-titration program were associated with greater BMI and DM, respectively. These findings may serve as benchmarks for up-titration programs.
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Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Volumen Sistólico
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Inhibidores de la Enzima Convertidora de Angiotensina
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Antagonistas Adrenérgicos beta
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Antagonistas de Receptores de Angiotensina
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Insuficiencia Cardíaca
Tipo de estudio:
Guideline
/
Risk_factors_studies
Límite:
Aged
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
Isr Med Assoc J
Asunto de la revista:
MEDICINA
Año:
2020
Tipo del documento:
Article
País de afiliación:
Israel