TY - JOUR
T1 - Prognostic role of β-blocker selectivity and dosage regimens in heart failure patients. Insights from the MECKI score database
AU - Paolillo, Stefania
AU - Mapelli, Massimo
AU - Bonomi, Alice
AU - Corrà, Ugo
AU - Piepoli, Massimo F.
AU - Veglia, Fabrizio
AU - Salvioni, Elisabetta
AU - Gentile, Piero
AU - Lagioia, Rocco
AU - Metra, Marco
AU - Limongelli, Giuseppe
AU - Sinagra, Gianfranco
AU - Cattadori, Gaia
AU - Scardovi, Angela Beatrice
AU - Carubelli, Valentina
AU - Scrutino, Domenico
AU - Badagliacca, Roberto
AU - Raimondo, Rosa
AU - Emdin, Michele
AU - Magrì, Damiano
AU - Correale, Michele
AU - Parati, Gianfranco
AU - Caravita, Sergio
AU - Spadafora, Emanuele
AU - Re, Federica
AU - Cicoira, Mariantonietta
AU - Frigerio, Maria
AU - Bussotti, Maurizio
AU - Minà, Chiara
AU - Oliva, Fabrizio
AU - Battaia, Elisa
AU - Belardinelli, Romualdo
AU - Mezzani, Alessandro
AU - Pastormerlo, Luigi E.
AU - Lenarda, Andrea Di
AU - Passino, Claudio
AU - Sciomer, Susanna
AU - Iorio, Annamaria
AU - Zambon, Elena
AU - Guazzi, Marco
AU - Pacileo, Giuseppe
AU - Ricci, Roberto
AU - Contini, Mauro
AU - Apostolo, Anna
AU - Palermo, Pietro
AU - Clemenza, Francesco
AU - Marchese, Giovanni
AU - Binno, Simone Maurizio
AU - Lombardi, Carlo
AU - Passantino, Andrea
AU - Perrone-Filardi, Pasquale
AU - Agostoni, Piergiuseppe
PY - 2017/7
Y1 - 2017/7
N2 - Aims: The use of β-blockers represents a milestone in the treatment of heart failure with reduced ejection fraction (HFrEF). Few studies have compared β-blockers in HFrEF, and there is little data on the effects of different doses. The present study aimed to investigate in a large database of HFrEF patients (MECKI score database) the association of β-blocker treatment with a composite outcome of cardiovascular death, urgent heart transplantation or left ventricular assist device implantation, addressing the role of β-selectivity and dosage regimens. Methods and results: In 5242 HFrEF patients, we investigated the role of: (i) β-blocker treatment vs. non-β-blocker treatment, (ii) β1-/β2-receptor-blockers vs. β1-selective blockers, and (iii) daily β-blocker dose. Patients were followed for 3.58years, and 1101 events (18.3%) were observed; 4435 patients (86.8%) were on β-blockers, while 807 (13.2%) were not. At 5years, β-blocker-patients showed a better outcome than non-β-blocker-subjects [hazard ratio (HR) 0.48, P<0.0001], while also considering potential confounders. A comparable prognosis was observed at 5years in the β1-/β2-receptor-blocker (n=2219) vs. β1-selective group (n=2216) (HR 0.95, P=ns). A better prognosis was observed in high-dose (>25mg carvedilol equivalent daily dose, n=1005) patients than in both medium dose (12.5-25mg, n=1431) and low dose (<12.5mg, n=1960) (HR 1.97, P<0.001; HR 1.95, P=0.001, respectively), with no differences between the last two groups (HR 0.84, P=ns). Conclusion: In a large population of chronic HFrEF patients, β-blockers were associated with a more favourable prognosis without any difference between β1- and β2-receptor-blockers vs. β1-selective blockers. A better outcome was observed in subjects receiving a high daily dose.
AB - Aims: The use of β-blockers represents a milestone in the treatment of heart failure with reduced ejection fraction (HFrEF). Few studies have compared β-blockers in HFrEF, and there is little data on the effects of different doses. The present study aimed to investigate in a large database of HFrEF patients (MECKI score database) the association of β-blocker treatment with a composite outcome of cardiovascular death, urgent heart transplantation or left ventricular assist device implantation, addressing the role of β-selectivity and dosage regimens. Methods and results: In 5242 HFrEF patients, we investigated the role of: (i) β-blocker treatment vs. non-β-blocker treatment, (ii) β1-/β2-receptor-blockers vs. β1-selective blockers, and (iii) daily β-blocker dose. Patients were followed for 3.58years, and 1101 events (18.3%) were observed; 4435 patients (86.8%) were on β-blockers, while 807 (13.2%) were not. At 5years, β-blocker-patients showed a better outcome than non-β-blocker-subjects [hazard ratio (HR) 0.48, P<0.0001], while also considering potential confounders. A comparable prognosis was observed at 5years in the β1-/β2-receptor-blocker (n=2219) vs. β1-selective group (n=2216) (HR 0.95, P=ns). A better prognosis was observed in high-dose (>25mg carvedilol equivalent daily dose, n=1005) patients than in both medium dose (12.5-25mg, n=1431) and low dose (<12.5mg, n=1960) (HR 1.97, P<0.001; HR 1.95, P=0.001, respectively), with no differences between the last two groups (HR 0.84, P=ns). Conclusion: In a large population of chronic HFrEF patients, β-blockers were associated with a more favourable prognosis without any difference between β1- and β2-receptor-blockers vs. β1-selective blockers. A better outcome was observed in subjects receiving a high daily dose.
KW - Equivalent dose
KW - Heart failure
KW - Prognosis
KW - β-Blocker selectivity
KW - β-Blockers
UR - http://www.scopus.com/inward/record.url?scp=85013625257&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85013625257&partnerID=8YFLogxK
U2 - 10.1002/ejhf.775
DO - 10.1002/ejhf.775
M3 - Article
AN - SCOPUS:85013625257
SN - 1388-9842
SP - 904
EP - 914
JO - European Journal of Heart Failure
JF - European Journal of Heart Failure
ER -